62-year-old Colorado Springs man looks forward to Obamacare

By Jakob Rodgers Published: December 7, 2013 | 8:15 am 0

John Soderberg retired early, only to end up in a race against time.

He was too young for Medicare - the health care coverage for almost anyone older than 65.

In the meantime, private insurance prices left him with few options but a high-risk, "catastrophic" plan.

But that should soon change.

Soderberg, a 62-year-old Colorado Springs resident, became one of thousands of baby boomers to sign up for health insurance this fall through the state's health insurance marketplace, Connect for Health Colorado.

His story is emblematic of a customer base that has become a mixed blessing for officials running the state's health insurance marketplace.

People ages 55 to 64 needed health insurance that seemed unattainable - likely forcing them to sign up quick, observers say. Through Nov. 23, 43 percent of enrollees were ages 55 to 64, more than any other age group.

But without more young people signing up in the coming months, experts fear that insurance risk pools might be out of balance - dominated by older people with costly health needs. Under that scenario, the premiums could rise in 2015 and beyond.

Beyond the age breakdown, no other information has been released on the characteristics of enrollees into the marketplace.

"Affordable insurance doesn't happen to one group at a time," said Matt Pfeifer, of the Chronic Care Collaborative. "It happens together."

Underinsured and waiting

Soderberg, though, fits the mold of many of his peers in the baby boomer generation: An early retiree who lacked adequate access to health care coverage until the marketplace opened Oct. 1.

His plan carried a $7,500 deductible, but he kept it because he and his wife are relatively healthy.

He's only visited the hospital once in the last 10 years, and the couple has relatively few chronic health concerns beyond high blood pressure.

But at nearly $600 a month, his insurance plan was financially draining - a typical situation for his age group.

"It's a huge risk that people take when they retire early before Medicare (eligibility)," said Suzanne Bragg-Gamble, CoverColorado's executive director.

Soderberg ranked among the underinsured - people who paid a disproportionate amount of their income on health coverage. More people ages 50 to 64 (17 percent) fell in this category than any other age group in the state, according to the 2013 Colorado Health Access Survey.

In part, those plans usually cost more for baby boomers because insurance companies could leverage prices based on age, as well as each policyholder's health, experts said. While age still factors into a policy's price, the Affordable Care Act, or Obamacare, set limits on how much carriers can charge based on age.

It also barred insurance companies from denying coverage because of pre-existing conditions.

Denials proved a problem for baby boomers in the past, because they have more health problems than younger counterparts.

Unable to buy coverage on the private market, many flocked to CoverColorado - a state-run entity that offered insurance to people unable to obtain coverage on the private market.

A quarter of the 13,816 people enrolled in CoverColorado this summer were ages 60 to 64. Another 45 percent of enrollees were ages 40 to 59, Bragg-Gamble said.

Early retirees whose former employers didn't offer retirement health care plans were vulnerable.

"It's up to them to find their own health insurance," she said. "And by the time you reach 55 - at least until January of this upcoming year - you could be turned down for anything, and most people were."

CoverColorado will shut down on March 31, 2014, leaving those people to find health insurance elsewhere.

Finding a plan

Soderberg's interest in the new insurance marketplace was jump-started by a letter from Anthem declaring his plan canceled.

He wasn't alone.

Nearly 250,000 other Coloradans received similar letters. Nearly all were offered the option of "early renewal," which allowed them keep their plans an extra year if they renewed by Dec. 31.

The "early renewal" option was a loophole approved by Colorado insurance regulators designed to temporarily circumvent the Affordable Care Act's requirement that each plan sold on or after Jan. 1 carry 10 core benefits, including substance abuse treatment and maternity care.

Unhappy with his plan in the first place, Soderberg shopped.

He attended several informational meetings hosted by Well3, a consortium of health care providers, insurance companies and health-based nonprofits.

And he hired a broker, one who sat with him while he logged onto Connect for Health Colorado's website, filed for federal subsidies and enrolled in a new Anthem plan.

On Jan. 1, he expects to pay $64 a month - rather than nearly $600 - for a plan with more benefits.

The fact the couple makes a bit above expanded Medicaid threshold - effectively 138 percent of the federal poverty level, or $21,500 for a couple - helped significantly.

"We're going to save a tremendous amount of money," Soderberg said. Now, he waits.

Soderberg has yet to get a bill from Anthem - the final step before he can submit a payment, and ensure he'll be covered on Jan. 1.

Until then, he risks going without coverage at the beginning of the year.

"I've still got my fingers crossed," Soderberg said. "I can't see how the whole thing will collapse . until I actually get the bill in the mail that I can subsequently pay, and know that I'm actually in the plan, I still have my concerns."

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