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Private Health Insurance: The Range of Base Premiums for Individuals Age 19 and 64 in the Individual Market by State in January 2013

GAO-14-263R Published: Jan 31, 2014. Publicly Released: Feb 04, 2014.
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What GAO Found

GAO reported the range of base premiums prior to underwriting for individual market health insurance plans as displayed on the Plan Finder in January 2013. The base premiums were for individuals aged 19 and 64 in each of the 50 states and the District of Columbia. The base premiums 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). They represented the lowest premium amounts that would have been available to different categories of individuals at that time; however, actual premium amounts paid by consumers could have been higher as they would have been determined after more complete underwriting for health conditions and other factors, and some individuals could have been denied coverage. 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. This supplements data on base premiums in the individual market in January 2013 for other categories of individuals and families presented in a previous report issued in July 2013 (see GAO-13-712R).

Why GAO Did This Study

Over 11 million Americans obtained health coverage by purchasing private health insurance in 2011. Prior to 2014, premium rates in most states' individual health insurance markets could have varied under applicable law based on age, gender, health status, and other factors. With certain exceptions, when health status was assessed through underwriting in 2013, individuals purchasing coverage in the private individual market could have been offered rates at a higher-than-average premium, or offered rates with a rider that excluded coverage of a preexisting condition. As of 2014, under the Patient Protection and Affordable Care Act (PPACA), insurers are no longer able to use gender or health status to set premiums and are restricted in the amount they can vary premiums based on age and tobacco use. As a result, beginning in 2014, the way insurers calculate base premiums may have changed. GAO was asked to report the range of premiums offered to different categories of consumers in the individual market in the month of January 2013. GAO examined the range of premiums for the individual market that was displayed on the 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 categories of consumers--specifically 19-year-old and 64-year-old nonsmoking and smoking individuals.



GAO is not making any recommendations. HHS reviewed a draft of this report and provided technical comments, which GAO incorporated as appropriate.

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