The Range of Base Premiums in the Individual Market by State in January 2013
GAO-13-712R, Jul 23, 2013 - GAO
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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.