How Marketplace Plans Set Your Health Insurance Premiums

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There are five factors that can affect Marketplace plan prices: location, age, family size, tobacco use, and plan category. Health status and gender DO NOT affect pricing.

Factors that can affect premium costs

Under the health care law, insurance companies can take into account only five things when setting premium costs.

  1. Age: Older people can be charged up to 3 times more for premiums than younger people.
  2. Geographic location: Where you live has a big effect on your premiums. Competition, local regulation, and cost of living in different areas account for this.
  3. Tobacco Use: Insurers can charge tobacco users up to 50% more than those who don’t use tobacco.
  4. Individual vs. family enrollment: Insurers can charge more for a plan that covers a spouse and/or dependents.
  5. Plan category: Plans are available in five categories: Bronze, Silver, Gold, Platinum, and catastrophic. The categories reflect how you and the plan share costs. Bronze plans will likely have lower premiums and higher out-of-pocket costs. Platinum plans are likely to have the highest premiums and lowest out-of-pocket costs.

States may limit how much these factors can affect premiums.

All Marketplace health plans cover the same list of essential health benefits. Insurance companies may offer more benefits than the minimum, which could also affect costs.

Factors that can’t affect premiums

  • Insurance companies can’t charge women more than men for the same policy.
  • They also can’t take health status into account when setting rates. All Marketplace policies must cover treatment for pre-existing conditions from the first day coverage begins.

For more information give us a call at 1.877.643.1260 or visit www.healthcare.gov

 

Attention: This website is operated by Benefinder and is not the Health Insurance Marketplace website. In offering this website, Benefinder is required to comply with all applicable federal laws, including the standards established under 45 CFR 155.220(c) and (d) and standards established under 45 CFR 155.260 to protect the privacy and security of personally identifiable information. This website may not display all data on Qualified Health Plans being offered in your state through the Health Insurance Marketplace website. To see all available data on Qualified Health Plan options in your state, go to the Health Insurance Marketplace website at HealthCare.gov.”

Also you should visit the Health Insurance Marketplace website at HealthCare.gov if:

  • You want to select a catastrophic health plan.
  • You want to enroll members of your household in separate Qualified Health Plans.
  • The plans offered here don’t offer pediatric dental coverage and you want to choose a Qualified Health Plan that covers pediatric dental services or a separate dental plan with pediatric coverage. Pediatric dental services are an essential health benefit.