Colorado Healthcare in 2027: A Small Employer's Guide
Several recent changes to the Colorado healthcare landscape will impact the decisions small business owners need to make during the upcoming open enrollment period. Cigna is leaving Colorado's individual health insurance market at the end of this year. Renewal quotes are landing now, open enrollment opens November 1, and a change to the state's definition of "small employer" that took effect in January is about to show up in a lot of renewal paperwork for the first time.
Healthcare is on almost every owner's mind right now, so it's one of two tracks at our free Level Up Academy Conference on October 23. By attending, you can bring your renewal questions to people who work in this every day.
In this post, we break down what changed, what Colorado is doing, and what to check before the deadline.
What’s changed in the healthcare landscape
Three separate things moved this year, and they hit different small business owners differently.
1. Cigna leaves the individual market, while Colorado Access joins
Cigna announced in June that it would stop selling individual plans nationwide. This matters for sole proprietors, owners without a group plan, and anyone whose business uses an individual coverage HRA to reimburse employees for their own plans. It does not touch employer group coverage.
Colorado Access, a Denver-based nonprofit that has operated mostly in Medicaid, is entering the individual market for 2027. The organization expects to offer plans in 14 counties in Boulder, Denver, Colorado Springs, and Pueblo areas.
2. Prices are up again
The Colorado Division of Insurance released the final approved premium information on private health insurance plans for 2027 for the individual market and the small group market. Premiums in Colorado are expected to increase, on average, 10% in the individual market, compared to the 15% national median, and 14% in the small group market.
3. The small employer definition moved from 100 to 50
SB24-073, signed in May 2024, redefined a small employer as one averaging 1 to 50 employees during the calendar year. The old definition went up to 100. The change took effect January 1, 2026.
If your business has 51 to 100 employees and had a small group plan before that date, you can keep it for five years from the date it was issued. During those five years you can change plans, but only to one level above or below what you have. Once you move to the large group market, you cannot come back to small group within that window. Large group plans are rated on your own group's claims experience rather than a community-wide pool, which changes how your renewal is priced.
What Colorado is doing to offset it
Two state programs are absorbing part of the federal change.
Colorado Premium Assistance is a state subsidy layered on top of federal tax credits for individual market enrollees between 100% and 400% of the federal poverty line. This program was created in response to the termination of enhanced federal tax credits at the end of 2025. It paid $80 a month for the primary household member and $29 a month for each additional member, up to five, in 2026. Connect for Health Colorado reports it helped more than 176,000 customers lower their premiums this year. This program is funded through 2027, but at a slightly lower level, providing $70 a month for the primary household member and $25 a month for each additional member.
Reinsurance is a state backstop for the most expensive claims. When one person has a catastrophic year, an insurance company would normally spread that cost across everyone else's premiums. Reinsurance has the state absorb part of those high-cost claims instead, so they don’t cause more of a spike in rates. The state sets the target at an 18% statewide average premium reduction, meaning individual market premiums land about 18% lower than they otherwise would. SB26-178, signed June 2, 2026, keeps the program running through plan year 2027 and pays for it with up to $100 million from bonds and a $40 million transfer from marijuana tax revenue.
What to check before November 1
If you buy your own coverage on the individual market
Confirm your insurance company is selling in your county for 2027. Connect for Health Colorado has also changed how renewals work. Eligible returning customers are now automatically re-enrolled at the start of open enrollment rather than during it, and that renewal does not guarantee your premium, financial help, provider network, or benefits stay the same. Review it rather than treating it as settled.
December 15 is the deadline for January 1 coverage, and January 15 closes the window for enrollment for 2027.
If you sponsor a group plan
Your renewal happens on your group's own anniversary date, not during individual open enrollment, so the November and December deadlines may not be yours. Ask your broker three things:
What your insurance company filed for 2027
Whether your insurance company is staying in the small group market
Whether a Colorado Option small group plan is priced competitively for your group
Every insurance company selling plans in the small group in Colorado is required to offer Colorado Option plans. Benefits are standardized across insurance companies, and they include $0 primary care and $0 mental health office visits as well as $0 continuous glucose monitors and diabetes supplies. Other benefits, like prescription medications must be copay only, making them more predictable than if they were offered with coinsurance.
If you have 51 to 100 employees
Find out the issue date on your current small group plan, because that is when your five-year clock started. Ask your broker what your large group renewal is likely to look like and when the transition makes sense to plan for.
If you are considering an individual coverage HRA
Confirm which insurance companies are selling individual plans in the counties where your employees live before you set a reimbursement amount. Cigna's exit changes plan options in 13 counties.
Bring your questions (and suggestions!) to Level Up Academy
Our annual conference is coming up on October 23. Level Up Academy is a free two-day educational and networking conference designed for entrepreneurs committed to driving social and environmental impact through their businesses. This year, healthcare is one of the two tracks. Join us and bring your renewal questions to people who work in this every day.