Health Team

Blue Cross: Older, sicker sought coverage under health law

Posted May 8, 2014

— The people who signed up for health coverage with Blue Cross Blue Shield of North Carolina through the Affordable Care Act's online marketplace are older and sicker than expected, which could mean higher premiums in the future, the insurer said Thursday.

Blue Cross was one of only two companies to offer plans in North Carolina through the online marketplace, and as of May 1, 232,000 people were on Blue Cross marketplace plans. Seventy percent of them didn't have coverage through Blue Cross previously, the company said.

Initial Blue Cross projections called for 50 percent of the marketplace customers to be 34 years old or younger, but after the enrollment period ended on March 31, the company found that only 32 percent of the people who signed up under the federal health care law fit that profile. Forty percent are ages 35 to 54, and 29 percent are 55 or older.

Younger customers are usually coveted by insurers because they are healthier and can balance out the spending of older customers who consume more medical services. But Blue Cross said even the younger customers who signed up for coverage through the online marketplace are sicker than one would expect.

Thirteen percent of enrollees ages 18 to 34 reported experiencing chronic pain as part of a Blue Cross self-assessment, compared with 8 percent for the age group as a whole. Seven percent have diabetes, compared with 4 percent of the group as a whole, and 24 percent said they have depression, compared with 14 percent for the group as a whole.

"The frequency and types of care ACA customers receive and the conditions for which they are being treated are key factors that will determine future premiums," Blue Cross said in a statement.

Other issues that could affect premiums in 2015 and beyond include changes in the Affordable Care Act, such as allowing people to remain on policies that don't meet the minimum coverage standards under the law, and how many people use their insurance to obtain needed medical services and then drop coverage before paying many premiums, the company said.


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  • miseem May 9, 2014

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    Maybe if the GOP had worked to improve the ACA with some changes such as dropping maternity care as of a certain age, have a higher deductible plan, etc. instead of spending all their time and hot air preaching about total repeal, with no realistic replacement plan (don't bring up your citation of that great GOP plan that contains nothing that would help, woody), we could have had a better plan. Having all states on board for the full roll out, including Meidcaid expansion, would have helped also. And by the way, for men anyway, you may need maternity coverage under a family plan even if you are 60+.

  • Doug Pawlak May 9, 2014
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    Overall, the Obama years have seen the smallest rate of health care increases in quite some time. The alternative is to do nothing. (The republican status quo plan)

  • icdumbpeople May 9, 2014

    You have not seen NOTHING yet. Wait until Jan. 1 2015 for those that work for a living and have insurance through jobs. Tick tock.. tick tock..

  • McLovin May 9, 2014

    yep - thats the good ole ACA that everyone wanted..NOT

  • Ty Shrake May 9, 2014
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    The private sector cancelled over 6 MILLION health insurance policies BECAUSE OF OBAMACARE. This has already been explained to you about 4,000 times but you still fail to grasp this essential fact.

  • Bob Cooke May 9, 2014
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    FYI..I'm a conservative commenter and I did go to the ACA website after my premiums skyrocketed and I even persisted through that awful site, just to find out that since I work hard and have a good income, my ACA premium was 133 percent higher for about the same coverage. I'm 60+ and don't need maturnity but now my policy has to cover it. This was an ill-conceived peice of legislature slammed through just so the Dems could say "We passed it !". Now I have no coverage, but now we have so many others that do. (how wonderful) Maybe I should get another job just to pay for my so afordable health care.

  • thomasew52 May 9, 2014

    Politicians have duped us again. They sold us a bill of goods by telling us that ACA is going to be the best thing since the invention of the wheel, and it is affordable on top of that. Of course, most of us knew better being that it is a government created program, and those that have been around any length of time know that about everything the government creates turns out to be bad for the regular folks. I don't recall meeting very many people that thought it was going to be good, but, we got it anyway. How do we keep this from happening, probably can't given the people that are running things in Washington. Is it possible to get people there who represent the main stream population? Doubtful that will happen either. If anyone running for office is for the mainstream people, once they get to Washington, they have to go along with the heavy weights that are the life long politicians, or get black balled.

  • Maurice Pentico Jr. May 9, 2014
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    The report on "Romneycare" exchange going to the Federal exchange (same as NC) because of technical failures. (Sound familiar?)

    Taxpayers will again be soaked for the $300 million it will take to "fix" the exchange.

    Money is simply printed... right?

  • Doug Pawlak May 9, 2014
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  • Maurice Pentico Jr. May 9, 2014
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    You ARE confused.

    Federal run or State run exchanges offered ANY insurance provider to participate... as long as they followed Obamacare rules. So NC's lack of participation has nothing to do with the GOP... and more about the rules and profitability.

    States that are seeing premiums cuts also happen to be where premiums are the highest. LOL.

    The so-called Heritage plan never even got out of committee. LOL. Worse still, the very "Romneycare" exchange you speak of went belly up last week. Again... a losing plan.

    Those nasty private sector folks you deride, just happen to be your neighbors... everyone from doctors, nurses, techs, drug manufacturers... heck chances are.. YOUR 401K is invested in these very companies, which in turn MUST be profitable or you lose money. Only govt run operations can lose money... cause it isnt their money to lose... its TAXPAYERS... like the BILLIONS lost every year by the post office.