Private Health Insurance: The Range of Base Premiums in the Individual Market by County in January 2013

GAO-14-772R Published: Sep 05, 2014. Publicly Released: Oct 06, 2014.
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What GAO Found                                      

GAO is reporting the range of base premiums prior to underwriting for individual market health insurance plans as displayed on the Plan Finder in January 2013 for every county 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). The data represent the base premium amount, rather than the actual premium amount, an individual may have been charged, because in 2013 insurers could have imposed different premiums on individuals on the basis of a variety of factors. Actual premiums could have been higher because they would have been determined after more complete underwriting for health conditions and other individual factors, and some consumers could have been denied any coverage, for example, due to preexisting conditions.

These data were reported for fourteen different categories of consumers including: smoking and nonsmoking males and females ages 19, 30, and 64; a family of four with parents aged 40; and a couple aged 55. This supplements state-level data presented in two previous reports, one issued in July 2013 (see GAO-13-712R) and the other issued in January 2014 (see GAO-14-263R).

Why GAO Did This Study

Prior to 2014, premium rates in most states’ individual health insurance markets could have varied under applicable law based on age, gender, health status, geographic region within the state, 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, offered rates with a rider that excluded coverage of a preexisting condition, or had coverage denied due to 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 premiums 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 county in each of the 50 states and the District of Columbia for fourteen different categories of consumers.

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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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