You Can’t Be Charged More Due to Gender or Health Status

ObamaCare means no discrimination. Under the ACA you can’t be charged more due to gender or health status on individual or small group plans sold after 2014. However there are certain factors such as age, tobacco use, family size, and geography which can be used to determine insurance costs to the consumer.

Before ObamaCare women paid up to a $1 billion more than men each year for identical health plans in the individual market. ObamaCare means insurers can’t discriminate based on health status or gender.

When Did the ACA’s Non-Discrimination Provisions Go Into Effect?

The provisions relating to eliminating discrimination in health insurance and health care began as the law was signed and rolled out until January 1st, 2014. Since Jan 1 women haven’t been able to be charged more than men and health status could not be used as a factor in determining the consumers insurance costs.

What Can I Be Charged More For?

While you can’t be denied coverage due to any factor there are still factors you can get charged more for:

Health insurance issuers in the individual and small group markets are only be allowed to vary premiums based on age (within a 3:1 ratio for adults), tobacco use (within a 1.5:1 ratio and subject to wellness program requirements in the small group market), family size, and geography.

What Can’t I Be Charged More For?

Aside those listed above, all other factors – such as pre-existing conditions, health status, claims history, duration of coverage, gender, occupation, and small employer size and industry are no longer able to be used by insurance companies to increase the premiums for those seeking insurance.

Are Some Plans Exempt?

Not all of the ACA’s protections (including bans on discrimination) apply to large group plans, self-insured businesses, grandfathered plans, or short term health insurance.

This Isn’t Fair, Why Should I Pay More Because of Other People?

Some young healthy men without a preexisting condition may feel it is unfair that they have to pay more to help insure up to 50 million Americans. However a few simple facts will do a lot to help you understand the why:

  • 1-2 Americans technically has a preexisting condition they could have been denied coverage or charged more for before ObamaCare.
  • About 50% of people in America are women, this includes your mother, sister, grandmother, wife, daughter, etc. You may not need maternity services, but your mother and many other females you care about in your life did or will.
  • Young men (and women) under 26 can stay on their parents plan.
  • 82% of young people qualify for Medicaid or cost assistance.
  • 6 in 10 uninsured can get covered for less than $100 a month.

If you are in the minority of young healthy men who paid more, try to take comfort in knowing that millions of others are benefiting due to those extra costs. Remember too that insurance premiums were rising at an unsustainable rate before the ACA and the law does a lot to curve that too.

Know the Law

Part I of Title I of the Affordable Care Act contains the sections that pertain to getting rid of discrimination in health insurance. Below are the relevant sections of the ACA that went into affect upon it’s signing.

Title I. Part I – Health Insurance Market Reforms

Sec. 2701. Fair health insurance premiums. Establishes that premiums in the individual and small group markets may vary only by family structure, geography, the actuarial value of the benefit, age (limited to a ratio of 3 to 1), and tobacco use (limited to a ratio of 1.5 to 1).

Sec. 2704. Prohibition of preexisting condition exclusions or other discrimination based on health status. No group health plan or insurer offering group or individual coverage may impose any pre-existing condition exclusion or discriminate against those who have been sick in the past.

Sec. 2705. Prohibiting discrimination against individual participants and beneficiaries based on health status.

‘‘(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan or coverage based on any of the following health status-related factors in relation to the individual or a dependent of the individual:

‘‘(1) Health status.

‘‘(2) Medical condition (including both physical and mental illnesses).

‘‘(3) Claims experience.

‘‘(4) Receipt of health care.

‘‘(5) Medical history.

‘‘(6) Genetic information.

‘‘(7) Evidence of insurability (including conditions arising out of acts of domestic violence).

‘‘(8) Disability.

‘‘(9) Any other health status-related factor determined appropriate by the Secretary.

Sec. 2706. Non-discrimination in health care. Prohibits discrimination against health care providers acting within the scope of their professional license and applicable State laws.

Check out our Summary of Provisions of the Patient Protection and Affordable Care Act for a plain English summary of each provision pertaining to the “benefits of ObamaCare”.

Non-discrimination in Health Care
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