How Marketplace Plans Set Your Health Insurance premiums

💰 What Affects Your Health Insurance Premium?

When shopping for a health plan through the Marketplace, it’s important to understand what factors can — and can’t — affect the cost of your monthly premium.

✅ 5 Key Factors That Can Affect Premium Prices

Under the Affordable Care Act (ACA), insurance companies can only consider these five things when setting your premium:

📍 Location
- Where you live matters. Costs vary based on local competition, regulations, and the overall cost of living in your area.
👵 Age
- Premiums may be higher for older individuals. In fact, insurers can charge up to 3 times more for older adults compared to younger enrollees.
🚬 Tobacco Use
- Tobacco users may pay up to 50% more than non-users for the same plan.
👨‍👩‍👧‍👦 Family Size
- Coverage for a spouse and/or dependents will increase the premium compared to individual coverage.
🩺 Plan Category
- Plans come in five categories: Bronze, Silver, Gold, Platinum, and Catastrophic.
  Lower-tier plans like Bronze typically offer lower premiums with higher out-of-pocket costs, while Platinum plans offer higher premiums but lower costs when you get care.

📌 Note: Some states may limit how much these factors can influence your premiums.

🚫 Factors That Cannot Affect Premiums

The law also protects you from unfair pricing based on:

❌ Gender
Insurance companies can’t charge women more than men for the same plan.
❌ Health Status or Pre-existing Conditions
You can’t be charged more if you’re living with a health condition.
All Marketplace plans must cover treatment for pre-existing conditions from Day 1.

📋 All Plans Cover the Same Essential Benefits

Every Marketplace plan includes a core set of essential health benefits, such as:

Doctor visits
Emergency services
Prescription drugs
Maternity care
Mental health services
And more

Some insurance providers may offer additional benefits, which can impact the overall cost of the plan.

This Medicare information section is here to educate you about your insurance options and provide you with the resources you need to help you select the right plan for your unique needs.

If there’s anything you need or if you have any questions, please feel free to contact us. We are here to help.