Skip to content

Return to the Full Article View You can republish this story for free. Click the "Copy HTML" button below. Questions? Get more details.

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.

<< View Previous Video

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.

More From This Series: Shopping For Coverage More Consumer Topics: Insuring Your Health

 

 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Some elements may be removed from this article due to republishing restrictions. If you have questions about available photos or other content, please contact khnweb@kff.org.