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Colorado Insurer’s Shift to HMO & EPO Plans to Control Costs

Colorado Insurer's Shift to HMO & EPO Plans to Control CostsAugust 1st, 2016 – According to a new report, the vast majority of health insurance company offerings through 19 health insurance exchanges across the country will be Health Maintenance Organization (HMO) or Exclusive Provider Organization (EPO) plans. Traditional Preferred Provider Organizations (PPO) plans have shrunk to a minority, making up just 25% of the plans in the 19 exchanges.

With both HMO and EPO plans, the insurance companies use fairly narrow networks of health care providers to help control costs, gain efficiency and increase quality. By leaving out hospitals and specialists with the highest costs from the HMO and EPO plan networks, insurers can control costs to help maintain better plan affordability.

According to the same report, in Colorado the shift will be even more dramatic with 99.5% of individual plans being HMO or EPO plans. The report states that just five out of 1000 individual health insurance plans in Colorado will be PPO plans in 2017. Previously, 20% of the Colorado’s individual health insurance plans were PPO plans.

Some HMO’s and EPO’s may require a referral from a Primary Care Physician in order to see a specialist. PPO plans which tend to be more expensive, but also offer larger selections of doctors and hospitals and include out-of-network coverage.

In June, Colorado’s Division of Insurance (DOI) confirmed that four insurance companies either will not offer or will significantly cut back individual plans in 2017. UnitedHealthcare and Humana will not offer individual plans at all and Rocky Mountain Health Plans will only offer its plans in Mesa County, in 2017. Anthem Blue Cross and Blue Shield decided it will not offer its PPO plans in 2017, but will be offering HMO plans to it’s members.

Bright Health Plans is the sole new entrant into the Colorado market in 2017 and will sell individual plans both on and off the exchange. Bright Health Inc. is a startup insurer that is utilizing Centura Health’s providers in Colorado for its new plans.

Open enrollment for the 2017 Open Enrollment Period re-opens on November 1st and continues through January 31st, 2017.

{ 4 comments… add one }
  • I.H. December 10, 2016, 8:02 am

    Hi, What is the individual option of PPO left in Colorado? I can’t find any? “just five out of 1000 individual health insurance plans in Colorado will be PPO plans in 2017.”

    • Mark Erickson December 14, 2016, 10:24 pm

      There is a Catastrophic PPO plan, which is generally only available to people under age 30, and also some PPO options for people living in Mesa county.

  • adrian ursua April 12, 2022, 10:03 pm

    My son just moved to Colorado. We are looking for a HMO….He has previous medical
    conditions that are expensive treatments and I don’t think having a PPO would be suitable for him. Are EPO’s available ? HMO’s ?

    thank you , Adrian Ursua

    • Mark Erickson April 13, 2022, 7:54 am

      Hi, There are both EPO’s and HMO’s available in Colorado’s individual market and all of the ACA compliant health insurance plans will cover pre-existing conditions. It’s important that your son get enrolled within the 60 day Special Enrollment Period of moving to Colorado. At this point, we should be able to get him a May 1st start date, but I would encourage him to get enrolled by Friday the 15th. If he hasn’t already filled out the quote request form he can do so here.

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