Is Gender Based Pricing Legal Under the ACA?
I have just received my employer health insurance information and it is broken down by gender then by age and the woman’s pricing is much higher than the male pricing and the older the more expensive as well. Is this legal?
Gender based pricing rules apply to new plans in the individual and small employer markets. They do not apply to grandfathered plans, large employers, or self insured businesses. Short term health insurance also doesn't have to follow the new rules.
This is true for many of the ACA's new benefits, rights, and protections.
The official reasons for this is:
- Grandfathered plans are generally exempt from new ACA protections. These plans will be phased out by 2017.
- Large employers typically have more negotiating power with insurers leading to (in theory) better deals for employees. This is typically true for self insured businesses as well.
Whether or not this has led to a good or bad experience for individuals on large group or grandfathered plans is another question.
Woman use the healthcare system much more than men. Logic would dictate they pay higher premiums.
The plan where I work is “grandfathered in.” I am in much better health than my male counterparts where I work and am younger and paying over 2x as much in my monthly cost for the same coverage they receive. I don’t have any kids and cannot have any and was told my rate was higher because I’m a female of “child bearing years.” I’ve never felt more discriminated against or livid over an issue anywhere I’ve worked. I hardly ever go to the doctor and take much better care of myself than my coworkers. Several have major health issues/diseases but pay a fraction of what I’m paying. I would say this has been a BAD experience. I hope that 2017 makes this practice illegal in the future.