More than half of those who have signed up for health insurance under the Affordable Care Act so far are at least 45 years old, more women than men are enrolling, and four out of five total enrollees are getting financial help.
In updating the progress of Obamacare over its first three months, Health and Human Services Department officials said Monday that 55 percent of the 2.2 million people who had selected health insurance plans on the federal or state health insurance marketplaces are 45 to 65 years old.
That percentage needs to change with an influx of younger, presumably healthier, policy buyers if the cost savings sought by federal health reform are to be realized.
“There is broad agreement that if young, healthy people forgo purchasing coverage while those who are older and costlier choose to sign up, then costs will increase for everyone with insurance,” said a statement issued by Aetna in response to the HHS report.
Government officials said they were confident the numbers would change by March 31, the deadline for obtaining individual coverage as mandated for 2014.
The agency said 54 percent of the policy sign-ups from October through December were by women. That’s a higher percentage than the gender breakdown previously found in the individual or group insurance markets.
An America’s Health Insurance Plans study of U.S. insurance carriers in 2011, for example, found that 50.8 percent of enrollees in the individual health health insurance market were women, as were 50.4 percent in group market health savings accounts and high-deductible health plans.
“Being a woman is no longer a pre-existing condition,” HHS Secretary Kathleen Sebelius said in a conference call Monday with reporters. That was a reference to the fact that before the health care overhaul, private insurance plans had been able to charge women more than men, and to consider pregnancy, for example, as a pre-existing condition to deny coverage.
The percentage of women buying federal marketplace policies was slightly higher than the national average in Missouri, 55 percent, and in Kansas, 56 percent.
The 2.2 million total enrollment figure falls far short of the 7 million targeted under the health care overhaul. But HHS officials on the conference call repeatedly said enrollments were meeting their expectations.
The government officials were unable to say how many or what percentage of enrollees have actually paid their premiums yet. They said “aggressive outreach” continues to explain and encourage sign-ups under the law that requires individuals to have health insurance coverage this year or pay a penalty.
Another data spotlight shone on the age of Americans signing up. The dominant age group by far was 55 to 64 years old, representing 33 percent of those who selected plans. That share also was slightly higher in Missouri, 36 percent, and Kansas, 34 percent.
Nationally, the next-largest age group were 45- to 54-year-olds, at 22 percent. Fifteen percent were 35 to 44, and another 15 percent were 26 to 34.
HHS officials said they expected the early influx of older enrollees.
“Younger people tended to sign up later,” said Nancy Delew, an HHS official, referring to enrollment experience in the Massachusetts state health exchange, a partial model for the national reform rollout.
Delew said federal and state marketplace enrollment shares were similar to the proportion of the age groups in the U.S. population as a whole.
“We expect a higher proportion of younger workers to enroll,” agreed Michael Hash, director of the HHS Office of Health Reform.
The enrollment deadline for 2014 coverage is March 31. Individuals had to enroll by the end of 2013 for coverage to be effective beginning in January.
Early data also showed that four out of five customers selected a plan that gave them some kind of financial assistance. HHS officials were unable to provide further details about the nature of the tax credits or Medicaid coverage.
Also, 60 percent of customers chose midlevel Silver plans and 20 percent chose the less expensive Bronze level of coverage. Less popular options were the more expansive Gold plans, selected by 13 percent, and Platinum plans, chosen by 7 percent. Only 1 percent chose the minimum Catastrophic coverage plan.
State governments in Missouri and Kansas declined to establish state-run health insurance marketplaces. Spokesmen for Blue Cross and Blue Shield of Kansas City and Coventry/Aetna, the two insurance companies offering plans on the federal marketplace that serves Kansas City area residents, declined to share any demographic breakdowns about their marketplace customers.
Newell Mitchell, an independent broker with Health Insurance Plans in Overland Park who has been helping individuals navigate the federal website, said his marketplace enrollees reflect the national data — over age 40, with an edge to women over men.
“I’ve only seen one or two young people,” Mitchell said, adding that he’d helped 18 women and eight men enroll on the federal exchange.
The women buying policies were a combination of single women, mothers with children to cover, and married women who could get better coverage at a lower cost on the federal marketplace than what they could get through their husbands’ work-related policies.
Mitchell said the biggest surprise to him has been how cheaply some people are able to get coverage through the federal marketplace.
“If they’re below 200 percent of the poverty level and make too much for Medicaid, they might be seeing zero premiums, zero deductibles and out-of-pocket costs capped at about $1,000 a year at the Silver level,” he said of some households.
He said the people he’s helping find policies are tending to find lower-cost options from Coventry/Aetna than from Blue Cross and Blue Shield.
To have coverage effective in January, Aetna enrollees were given until today to pay for their premiums, and Coventry members have until Friday. Blue Cross and Blue Shield of Kansas City set a Jan. 7 deadline to pay premiums for January coverage. The insurance companies declined to give details about payment histories so far.
Sebelius said people can research coverage options at healthcare.gov, call 800-318-2596, or go through an agent, broker or insurance issuer. Trained navigators may be found atlocalhelp.healthcare.gov.