CO| The Colorado Division of Insurance released Amended Regulation 4-2-78 (3 CCR 702-4), that sets standards for Health Insurance Affordability Enterprise on-exchange enhanced premium subsidies and applies to all carriers issuing non-grandfathered individual health benefit plans beginning with benefit year 2027 and annually thereafter.
Starting in 2027, the Enterprise will provide an enhanced premium subsidy to every eligible enrollee — defined as a Qualified Health Plan enrollee with household income at or below 400% FPL — calculated on household income relative to FPL, household size, and the premium balance remaining after federal advance premium tax credits (APTC): the lesser of $70 PMPM or the post-APTC balance for the first household member, and the lesser of $25 PMPM or the post-APTC balance for each additional premium-paying member, with no subsidy applied to dependents under 21 beyond three who have $0 premium.
The Exchange identifies eligible enrollees during enrollment, applies the subsidy after federal APTC (displaying rates net of both), and carriers receive in-year reports of subsidized enrollees and amounts owed; the Enterprise, through the Division, must pay carriers by June 30, 2028 for the 2027 benefit year based on actual benefit-year enrollment, using exclusively state Enterprise funds tracked in a separate appropriation unit with no reliance on Colorado’s ACA Section 1332 waiver or federal dollars.