Personal Health Insurance - Base Premium Rates in the Individual Market (2013)

Studies show that up to 15 million Americans (6%) have a personal health insurance plan (also called an individual or family health insurance plan). This includes the self-employed, small business owners, employees with a pure defined contribution health plan, and employees without access to employer-sponsored health insurance.

With major provisions of health reform taking effect in 2014, many experts agree the landscape of health insurance is rapidly changing for both employers and employees. One of the most significant changes is a shift toward the individual health insurance market. For example, of the 48 million currently uninsured, it's expected that 19 million individuals will be eligible for the new health insurance premium subsidies available through the state health insurance marketplaces.

Starting in 2014, insurers will no longer be able to use gender and health status to set personal health insurance plan premium rates and will be restricted in the amount they can vary premiums based on age, tobacco use, and location.

With the opening of the state health insurance marketplaces, the individual mandate, and all personal health insurance plans becoming guaranteed-issue in 2014, employers, employees, and health insurance brokers have been eagerly waiting to see what will happen to premium rates for personal health insurance plans in 2014.

To provide a baseline of premium rates in 2013, the Government Accountability Office (GAO) examined base premium rates for health insurance on the individual market.

The GAO used individual market rates displayed on healthcare.gov "Plan Finder" in January 2013. Here are their findings.

Personal Health Insurance Base Rates - 2013

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 study provided state by state rates, by age of consumer, and type of plan.

30-Year Old Single Female Base Premium Rates

For a 30-year old single female, nonsmoker, the national average is $222/month. Here is the breakdown for this demographic, by state. These average monthly rates represent plans with median premiums.

State		State		State
Alabama	$163	Kentucky	$140	North Dakota	$112
Alaska	$186	Louisiana	$163	Ohio	$166
Arizona	$119	Maine	$774	Oklahoma	$183
Arkansas	$103	Maryland	$223	Oregon	$139
California	$186	Massachusetts	$287	Pennsylvania	$201
Colorado	$202	Michigan	$118	Rhode Island	$291
Connecticut	$198	Minnesota	$128	South Carolina	$227
Delaware	$145	Mississippi	$172	South Dakota	$228
District of Columbia	$176	Missouri	$171	Tennessee	$182
Florida	$129	Montana	$119	Texas	$153
Georgia	$143	Nebraska	$178	Utah	$141
Hawaii	$441	Nevada	$160	Vermont	$208
Idaho	$164	New Hampshire	$176	Virginia	$154
Illinois	$181	New Jersey	$1,436	Washington	$168
Indiana	$180	New Mexico	$135	West Virginia	$152
Iowa	$138	New York	$479	Wisconsin	$144
Kansas	$158	North Carolina	$161	Wyoming	$208

Source: GAO.

55-Year Old Couple Base Premium Rates

For a 55-year old couple (two non-smoking adults), the national average is $815/month. Here is the breakdown for this demographic, by state. These average monthly rates represent plans with median premiums.

State		State		State
Alabama	$629	Kentucky	$524	North Dakota	$553
Alaska	$890	Louisiana	$657	Ohio	$703
Arizona	$465	Maine	$2,138	Oklahoma	$832
Arkansas	$386	Maryland	$679	Oregon	$624
California	$835	Massachusetts	$1,103	Pennsylvania	$856
Colorado	$794	Michigan	$463	Rhode Island	$871
Connecticut	$871	Minnesota	$547	South Carolina	$954
Delaware	$604	Mississippi	$693	South Dakota	$1,031
District of Columbia	$799	Missouri	$655	Tennessee	$785
Florida	$697	Montana	$521	Texas	$612
Georgia	$581	Nebraska	$841	Utah	$571
Hawaii	$1,734	Nevada	$675	Vermont	$565
Idaho	$704	New Hampshire	$842	Virginia	$635
Illinois	$627	New Jersey	$2,926	Washington	$794
Indiana	$747	New Mexico	$567	West Virginia	$702
Iowa	$642	New York	$828	Wisconsin	$586
Kansas	$660	North Carolina	$702	Wyoming	$1,021

Source: GAO.

Study Methodology

The GAO 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.

The data included insurers’ base premiums for health plans that were publicly available to consumers through the Plan Finder in the month of January 2013. The base premium amounts and supporting plan information were self-reported by each insurance company, and each company was required to comply with a data validation and attestation process. However, the analysis may not reflect the entire universe of insurers’ base premiums because roughly 20 percent of all insurance companies did not submit data.

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).

Read the full GAO study and methodology notes here.

What do you think? Are these rates found in the GAO study reflective of personal health insurance rates in the individual market? Let us know in the comments below.