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What Were Private Health Insurance Premiums after Key PPACA Insurance Provisions Took Effect?

GAO-15-687, August 10, 2015

As of 2014, the Patient Protection and Affordable Care Act (PPACA) changed how insurers determine health insurance premiums and how consumers shop for individual market health insurance plans. For example, PPACA:

  • prohibited insurers from denying coverage to any individuals;
  • prohibited insurers from varying premiums based on factors other than age, geographic location and tobacco use—for which limits were established;
  • effectively prohibited premium variation based on health status or gender;
  • established minimum benefits that must be covered by health plans;
  • required health plans to be classified into one of four metal tiers—bronze, silver, gold, and platinum—based on the percentage of medical expenses estimated to be paid by the insurer; and
  • required the establishment of health insurance exchanges in each state—marketplaces through which consumers can compare and select health insurance coverage from among all the health plans participating in the exchange.

For both 2014 and 2015, GAO obtained data on individual market (non-group) plan premiums. The states in this map each link to files showing the range of health insurance premiums for two categories of individual market plans (exchange plans and all plans) that were available to these selected categories of hypothetical consumers:

  • Single nonsmoker, aged 19
  • Single nonsmoker, aged 30
  • Family of four, nonsmoking parents aged 40
  • Nonsmoking couple, aged 55
  • Single nonsmoker, aged 64

Click a state for a file showing—by county—the premium amounts by metal tier and availability on an exchange, for the individual (non-group) plans with the minimum, median, and maximum premium values.

  No data
  Partial data
  Complete data

Source: GAO analysis of Center for Consumer Information and Insurance Oversight data. | GAO-15-687.

The files do not contain all information for all states because some data was not sufficiently reliable to report. For example, GAO did not report data if it determined that the data were for fewer than 70 percent of plan offerings in a given state for a given year. The states with dark gray shading indicate that the linked spreadsheets include complete data for that state—including data for both years and for both categories of plans. The states with light gray shading indicate that the linked spreadsheets include partial data for that state, such as only for one category of plans or one year. One state (Washington) and the District of Columbia are not shaded and contain no data because the data were not sufficiently reliable in either year.

Notes: Data reflect available information for plans sold to provide health insurance coverage for the years 2014 and 2015, and may include plans with little or no enrollment. “Exchange plans” means plans that were available on an exchange, and “all plans” means all plans whether or not they were available on an exchange.

Under PPACA, premiums for smokers can be up to 50 percent higher than premiums for nonsmokers.