As a cancer survivor, Alex Modisette doesn’t want to go without health insurance, but she doesn’t see another option as her family’s monthly costs are set to rise more than 140%.
Modisette, who owns a small construction business with her husband in Castle Rock, said they currently pay about $175 a month for insurance bought on the state’s marketplace. When enhanced federal subsidies expire in January, the family’s monthly cost would jump to $430, which isn’t feasible, she said.
While she’s been in remission from thyroid cancer for 10 years, Modisette still needs periodic blood tests and medication to replace hormones her thyroid would have produced.
While their two children qualify for Child Health Plan Plus — which covers kids from families that earn too much for Medicaid — Modisette and her husband don’t have a public coverage option and are contemplating going without insurance. Other small business owners she knows are in a similar position, since they don’t have job-based coverage.
“It’s real people that are working really hard to build something of your own,” Modisette said. “If something bad happens, are we going to go bankrupt?”
Monthly health insurance premiums are poised to double next month for hundreds of thousands of Coloradans who have been receiving enhanced pandemic-era subsidies on the individual marketplace, according to the state’s Division of Insurance. About 321,000 people received those subsidies in Colorado last year.
The loss of those subsidies, which Congress has so far declined to extend, at the end of this month will force individual marketplace customers across the nation to shoulder a larger share of their premiums in 2026.
The Denver Post spoke to Coloradans facing large premium increases about the choices they face as their insurance costs increase.
People facing significant increases have three general choices: find another source of coverage, choose a less expensive plan within the individual marketplace – with the possibility of facing more out-of-pocket costs if they need care – or go without insurance, meaning they would have to pay the full price for any medical care they need.
Customers who wanted their insurance to start Jan. 1 needed to pick a plan by Monday. Those who haven’t could still choose Jan. 15 for coverage starting in February.
Congress adjourned without passing any bills to extend the subsidies, but the House of Representatives will take up the issue in January. Four Republicans defied House Speaker Mike Johnson, who wants to move on, and joined a Democratic “discharge petition” that will force leadership to hold a vote on a bill that would extend the subsidies for three years, with no major changes.
Such a bill would face challenges in the Senate. The chamber voted down a three-year extension earlier this month. A Republican alternative, which would have placed $1,000 into health savings accounts, with the sum increasing to $1,500 for people between 50 and 64, also failed.
House Republicans passed a bill expanding coverage options for small businesses and self-employed people, but it will likely die in the Senate, where it would need at least some Democratic support to move forward. Other Republican proposals continue to circulate, though none yet have the support to pass.
If Congress extends the subsidies in January, the state-run marketplace, Connect for Health Colorado, would have to shut down temporarily to reprogram. Congress could make the enhanced subsidies retroactive, protecting customers from the rate increase coming at the start of the year.
‘Health insurance is rapidly becoming my mortgage’
Roger Allbrandt, of Centennial, said that if Congress doesn’t act, the subsidy for the plan covering him and his wife Claudia will drop from $1,036 to $503, raising their monthly premiums from about $35 to $862.
About two-thirds of their increase in cost comes from reductions in subsidies, and one-third comes from an increase in the overall cost of the plan.
Claudia recently started a new teaching job that provides insurance, but adding Allbrandt to her plan would put the monthly cost over $1,000. He’s planning to rely on the Rocky Mountain Regional VA Medical Center in Aurora for primary care and any emergencies.
They liked their coverage through the Denver Health Medical Plan, but the increase is more than their budgets can handle, he said.
“I never have an extra $800/month to pay for health insurance. No way we can even consider the DHMP plan,” he said in an email.
Kate Tynan-Ridgeway, a retired Denver Public Schools teacher who lives in Littleton, said she also is moving to a less-than-ideal coverage option. Her premiums on the marketplace would have risen from about $600 a month to $1,200, so she decided to buy insurance through the Colorado Public Employees Retirement Association, at about $800 a month.
The PERA plan comes with a $4,000 deductible, which is about twice the amount her previous insurance required, Tynan-Ridgeway said. Patients pay a larger share of their health care costs before hitting the deductible, with lower-premium plans requiring patients to pay for everything other than preventive services they legally must cover until they hit the deductible.
“I’m making harder decisions about when to seek health care,” she said.
Her husband, Patrick Ridgeway, aged onto Medicare this summer, which reduced their insurance expenses, Tynan-Ridgeway said. But she’s still considering picking up some odd jobs to offset the increased cost, she said.
“I don’t have a mortgage, and I feel like health insurance is rapidly becoming my mortgage,” she said.
In a nationwide survey by the health policy group KFF, about one-third of marketplace enrollees said they would shop for a different plan if their costs doubled, and one-quarter said they would consider going without insurance.
About half said they already have some difficulty affording premiums, and three-fifths said they have trouble paying their deductible.
‘I worked hard, I did what I needed to do’
Myshel Guillory, of Eagle, would have preferred to stay in the individual market, but determined she’ll probably be better off paying out of pocket.
She was counting on health care costs rising 5% to 8% annually when she retired two years ago, but the price of insurance more than doubling threw off her plan.
The most affordable plan Guillory found would cost about $1,000 a month and have a $12,000 deductible. If she had an injury or illness severe enough to meet the deductible, health care would eat up one-quarter of her budget that year, Guillory said.
She looked for jobs with insurance around Eagle, but hasn’t gotten any callbacks, and is planning to go without coverage until either the subsidies return or she qualifies for Medicare in 10 years.
Friends of hers who planned to retire in their early 60s and use the individual marketplace as a bridge to Medicare are now holding onto those jobs, which doesn’t serve them or people who’d like to move up in their careers, she said.
“I planned, I worked hard, I did what I needed to do,” she said. “Sure, I have $1 million in the bank, but that needs to last.”
Most people who will receive subsidies next year can still find an affordable option, particularly if they’re willing to consider a different company or to pay more if they need care, said Leah Denzel, an insurance broker and owner of Rocky Mountain Benefits. People earning more than four times the poverty line, or about $62,000 for an individual, will no longer qualify for any assistance with their premiums.
The amount of the tax credit is based on the second-cheapest silver level plan available in each area, but customers can use it to buy any bronze, silver or gold plan, Denzel said. Bronze plans have lower monthly premiums and higher out-of-pocket costs for using care, while gold plans have the opposite design and silver plans land in the middle.
“For most people, there are options,” she said.
People near 400% of the poverty line have to make harder choices, though, particularly if their income can vary from year to year, Denzel said. The enhanced subsidies allowed people with incomes over that threshold to receive assistance for the first time.
In addition, the Trump administration has announced that people who received some level of subsidy, but then end up earning too much to qualify for it, will have to pay back the full amount, Denzel said. Anyone who might be close to the line will need to watch their income carefully, so they can claim subsidies if they qualify and drop them if their business picks up, she said.
While no one knows what Congress may do, Denzel said she’s recommending her clients choose an Affordable Care Act plan they can afford without the enhanced subsidies — and that they avoid short-term plans or health-sharing ministries that look cheaper, but aren’t required to cover pre-existing conditions.
“If they have any health conditions, they need an ACA plan,” she said.
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