Individuals With Medical Conditions Will Not Pay A Penalty On Premiums

Insuring Your Health columnist Michelle Andrews helps you navigate the new insurance marketplaces that are scheduled to launch on Oct. 1.

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Q: Is everyone who qualifies treated the same in this new marketplace? Do younger people get lower rates and people with pre-existing conditions get higher rates?

A: Starting next year, no one can be charged higher rates for health insurance because they have pre-existing medical conditions. But there are a few other individual details that insurers can factor in when setting premiums, including age and tobacco use. The law allows premiums for older people to be up to three times higher than those of younger people. That may seem like a lot, but in plans currently sold on the individual market, the differential between the two is often much greater.

The law also allows insurers to charge smokers 50 percent higher premiums for coverage on the exchanges than non-smokers. Smokers do tend to have higher health care costs than non-smokers. Still, a handful of states have decided not to implement this surcharge. They figure that the higher premiums may make coverage unaffordable for some smokers, who typically have lower incomes in the first place. Besides, they say, evidence is scant that charging people more for health insurance actually encourages them quit smoking.

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