Age Rating


Older patients typically utilize more, and higher cost health care services than younger patients. One way states can ensure that coverage remains affordable for everyone is to use age rating bands that spread premium costs over a range of age groups.  For example, in a state with a 5:1 age band, the ratio limits the amount an older individual will pay to no more than five times what a younger individual pays in premium dollars. Currently 42 states have age rating bands that are 5:1 or more.   

Age Rating


Starting January 1, 2014, the law limits the age rating band to 3:1, causing an overnight increase in premiums for younger individuals (ages 18-49) that live in states that currently have higher age bands. This increases the likelihood that younger, healthier people will choose to pay the penalty and wait to purchase health insurance until after they get sick or injured, thus driving up costs for everyone else. An article from actuaries at Oliver Wyman published in Contingencies highlights the impact of the Affordable Care Act’s (ACA) age rating restrictions on premiums.

Age Rating - Infographic Age Rating Infographic II 
Age Rating Age Rating Restrictions  


To see how age rating will affect premiums, watch AHIP's new video:  

Latest Resources

Comprehensive Assessment of ACA Factors That Will Affect Individual Market Premiums in 2014

A new report from Milliman, Inc. helps explain how the Affordable Care Act’s (ACA) coverage expansion, new benefits, and market reforms will impact individual market health insurance premiums in 2014. The report highlights how some provisions will increase premiums while others will make health care coverage more affordable for consumers. The focus of this report is to highlight the broad range of changes happening in the marketplace and the wide variation in impact that is likely to occur.

Reports/Research/White Papers | Strategic Communications | 04/25/2013

Impact of Market Reforms on Affordability - [PDF]

This presentation from Oliver Wyman examines the impact of ACA market reforms on affordability.

Reports/Research/White Papers | 03/13/2013

AHIP Statement on Age Rating

America’s Health Insurance Plans (AHIP) President and CEO Karen Ignagni released the following statement in response to new rules released today by the U.S. Department of Health and Human Services (HHS) finalizing the age rating restrictions included in the health care reform law.

Press Releases | Strategic Communications | 02/22/2013

Age Rating Restrictions: Threatening Affordability for All Ages - [PDF]


Infographics | Strategic Communications | 01/17/2013

New Study Finds ACA’s Age Rating Restrictions will Increase Premiums for Younger Individuals

America’s Health Insurance Plans (AHIP) has raised concerns about the impact the ACA’s age rating restrictions will have on the affordability of health care coverage. 

Press Releases | Strategic Communications | 01/07/2013

Impact of Changing Age Rating Bands in “America’s Healthy Future Act of 2009” - [PDF]

Oliver Wyman has developed an actuarial model to study the impact of different reform proposals on the individual and small employer health insurance market.  According to this model, if the age band is compressed to 3:1, premiums for the youngest-healthiest third of individuals would be 35% higher in Year 1 compared to reform with 5:1 rating bands.

Reports/Research/White Papers | 09/28/2009