How Are Health Insurance Premiums Calculated?

Health insurance rates and plans depend upon many factors, including your own health history, where you live, state insurance laws, your gender, your age, and even your credit report! This can make the process of shopping for an individual health insurance plan a very long and complex process.

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Various health insurance companies may add to your premium if you have a history of health claims. Furthermore, some health habits can add to your premium, even if you have not made any claims. Smoking and carrying excess weight are two examples of that. Some health problems may increase your premium by 25% – 50%, especially if they are combined by some poorer health habits.

Health insurance companies may even decline coverage to some applicants with more severe health problems. In that case, every state has some sort of high risk coverage plan. You will need to contact your state insurance department or a qualified health insurance agent for help.

On the other hand, good health habits like abstaining from smoking or drinking, and maintaining a normal weight, may qualify you for health insurance discounts. These discounts can shave more than 20% from a standard price. Some insurance companies may allow these discounts for applicants of any age, but some may cut them off at a certain age band like 39 or 49. Middle aged applicants may have trouble finding discounts no matter how healthy they are.

To make matters more complicated, insurance companies do not all give the same weight to various factors. A high blood pressure history may get a substantial rate up by one company, but be considered standard by another company. If blood pressure is high on one doctor’s visits, you may be able to qualify for a lower rate if you can manage it for six months with diet, exercise, or medication.

Keep in mind that even within the same health insurance company, different health plans may have different underwriting guidelines. Higher deductible health plans tend to have easier underwriting and less rate increases than health plans that are designed to cover every single trip to a medical provider.

So what can you do to find the lowest health insurance rates? First, you must decide why you are buying health insurance, and that should be to protect your financial situation in case of a major health problem. If worked for a company that provided health insurance, or at least one that paid part of the plan’s premium, you may have to accept a higher deductible plan when you must pay the whole premium yourself.

Second, you must compare the rates and plans that are available in your area. Insurance regulations vary by state. That means that some states mandate coverage that will make premiums more expensive. The cost of health services vary by zip code. The cost of health services in an area will affect the premium too. So it is impossible to tell a person which medical plan they should consider without knowing where they live, what their budget is, and what their expectations are.

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