Private Health Insurance:

The Range of Base Premiums in the Individual Market by State in January 2013

GAO-13-712R: Published: Jul 23, 2013. Publicly Released: Jul 23, 2013.

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What GAO Found

GAO reported the range of base premiums prior to underwriting for health insurance in the individual market that were displayed on the HealthCare.gov Plan Finder in the month of January 2013 for each of the 50 states and the District of Columbia. The base premiums displayed on the HealthCare.gov Plan Finder reflected information from data submitted by insurers to the Center for Consumer Information and Insurance Oversight (CCIIO) within the Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS). Included were ranges for six different types of consumers: 1) 30-year-old, single, nonsmoking male; 2) 30-year-old, single, smoking male; 3) 30-year-old, single, nonsmoking female; 4) 30-year-old, single, smoking female; 5) a family of 4 with 2 parents, aged 40; and 6) a couple, aged 55. GAO also reported on base premiums prior to underwriting for an urban and rural zip code in four select states, one from each census region. The states included: Illinois, Nevada, Pennsylvania, and Texas.

Why GAO Did This Study

Over 11 million Americans obtain health coverage by purchasing private health insurance. Currently, premium rates in most states' individual health insurance markets may vary under applicable law based on age, gender, health status, and other factors. With certain exceptions, when health status is assessed through underwriting, individuals purchasing coverage in the private individual market can be offered rates at a higher-than-average premium, or offered rates with a rider that excludes coverage of a preexisting condition. Beginning in January 2014 under the Patient Protection and Affordable Care Act (PPACA), insurers will no longer be able to use gender and health status to set premiums and will be restricted in the amount they can vary premiums based on age and tobacco use, among other provisions. As a result, beginning in 2014, the way insurers may calculate base premiums prior to underwriting may change. GAO was asked to report the range of premiums offered to consumers in the individual market in the month of January 2013. We examined the range of premiums for the individual market that were displayed on the HealthCare.gov Plan Finder, which reflected insurers' base premiums prior to underwriting. A range was developed for each of the 50 states and the District of Columbia and for urban and rural zip codes in select states for different types of consumers.

What GAO Recommends

GAO is not making any recommendations. GAO provided HHS with a draft of this report for review; it had no comments.

For more information, contact John E. Dicken at (202) 512-7114 or dickenj@gao.gov.

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