Discrimination and the New Rules About Insurance Premiums

Last updated: March 30, 2016

The Four Factors

Under the Affordable Care Act (ACT), there are only four legal factors used to set premiums:

  • A person’s age

  • The area of the state in which the policy is sold

  • Tobacco use

  • And family composition

Insurance companies can’t refuse to insure or charge higher premiums to people with medical problems.

The ACA also reduces the difference in premiums charged for younger and older people. It also eliminates differences between premiums charged for men and women.

Health plans in the individual and small group markets must cover certain services.

To help make coverage affordable:

  • Many people who buy health insurance in the individual market will be eligible for premium tax credits and

  • People under age 30 or who can’t afford coverage may be eligible to buy catastrophic plans. Catastrophic plans cost less.

The ACA Addresses Discrimination

The ACA prohibits insurance companies from discriminating on the basis of:

  • Age

  • Disability

  • Expected length of life

  • Race

  • Color

  • National origin

  • Sex

  • Gender identity

  • Or sexual orientation

These nondiscrimination standards apply to:

  • The Exchanges and Exchange activities

  • Issuers and insurance plans

  • And the essential health benefits among others

Also, health insurers must obey any applicable state laws and regulations regarding marketing by health insurance issuers. They cannot employ marketing practices or benefit designs that discourage the enrollment of individuals with significant health needs in health insurance coverage. It cannot discriminate based on an individual’s race, color, national origin, present or predicted disability, age, sex, gender identity, sexual orientation, expected length of life, degree of medical dependency, quality of life, or other health conditions.

Insurance companies won’t pay for services not covered by a plan. For example, they will not pay for care that isn’t medically necessary.

  • However, you have the right to ask their insurance company to reconsider a decision to deny coverage.

  • After that, you have the right to an independent, external review of the decision.

This article is published on KansasMoney.gov. Find more information by contacting these state agencies: