ACA Underwriting Restrictions: What States Prohibit Age-Based Premiums?

The Affordable Care Act (ACA) has transformed the health insurance landscape in the United States. One key provision of the ACA is the prohibition of age-based underwriting for health plans. This means that insurance companies cannot charge older individuals higher premiums simply because of their age.

States with Age-Undifferentiated Premiums

In addition to New York, which was mentioned in the post, there is only one other state that prohibits age-based underwriting for ACA plans:


Vermont passed a law in 2011 that banned age-rating for ACA plans, making it the second state in the nation to do so.

Benefits of Age-Undifferentiated Premiums

The ban on age-based underwriting ensures that individuals of all ages have access to affordable health insurance. This is particularly important for older adults, who often have higher healthcare costs than younger individuals. Without age-rating, older adults would be forced to pay prohibitively high premiums, making it difficult for them to obtain coverage.

Implications for Health Insurance

The elimination of age-based underwriting has had a significant impact on the health insurance market. Insurance companies can no longer rely on age as a factor in determining premiums, which has led to a more competitive and equitable market. Furthermore, it has helped to make health insurance more affordable for older individuals, who were previously discriminated against by insurers.

Additional State Regulations

While most states allow for some degree of age-rating for ACA plans, the extent of this rating varies by state. Some states, such as California and Massachusetts, have implemented age curves that limit the amount by which premiums can vary based on age. Other states, such as Florida and Texas, have no such age curves, allowing insurers to charge significantly higher premiums for older individuals.

It is important to note that the ACA does not prohibit age-based underwriting for plans that are not sold through the Health Insurance Marketplace. This means that individuals who purchase health insurance directly from an insurer may still be subject to age-rating.

If you are concerned about the cost of health insurance, it is important to contact a licensed agent to discuss your options.

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