Insurer filings to the National Association of Insurance Commissioners (NAIC) are a standardized source of information on health plan premiums and expenditures in the aggregate at the state level. The data - compiled by Mark Farrah Associates - shows how average premiums in the individual insurance market varied across the country for 2010.
Nationwide, the average monthly premium per person in the individual market in 2010 was $215, but the state-by-state range was substantial. Vermont and Massachusetts both had average per member per month premiums over $400 per month. The average premium revenues in Rhode Island, New York, and New Jersey were also relatively high, ranging from about $344 to $364 per month. Alabama ($136), California1 ($157), Arkansas ($163), Idaho ($167), and Delaware ($169) had the lowest average monthly premiums in the country. (Note that these figures represent average premium revenue per member per month. This represents an average across adults and children, so will be lower than a typical premium charged to a single adult.)
Why the Variation?
There are a variety of reasons why premiums might vary, including: the cost of living, health care costs, state demographics (e.g., the age distribution of the population), plans' effectiveness at controlling costs, the benefits offered by plans, and the patient cost-sharing required. Though premiums are lower in some states, the people enrolled in these plans may have to pay higher deductibles or copayments that offset the savings in premiums. Thus, the map above does not take into account the relative protection offered by the plans. Also, states that have instituted reforms in their insurance markets to make coverage more accessible - such as Massachusetts, Vermont, New York, and New Jersey - may have higher average premiums because people with pre-existing health conditions are able to enroll. Conversely, states that permit medical underwriting may have average premiums that are low because the risk pools include a healthier than average population.
Health Care Reform Will Narrow the Variation Among States
Starting in 2014, the health reform law (ACA) will require insurers to cover a standard essential benefit package in all states and to use defined tiers of cost-sharing. The minimum cost-sharing tier will require that all newly-purchased insurance in the non-group market have an actuarial value of at least 60%, meaning that the plan pays for at least 60% of the cost of covered benefits in the aggregate for a typical population. In addition, tax credits will be available to make coverage more affordable for people with incomes up to 400% of the poverty level ($43,560 for a single individual and $89,400 for a family of four in 2011 dollars). These changes should all help to narrow the variation in the insurance people buy in different areas of the country. But, a wide range of insurance policies will still be available (ranging from Bronze coverage at an actuarial value of 60% to Platinum coverage at an actuarial value of 90%), so patterns of purchase may still vary substantially across the country. The health reform law will also require all insurers in the individual (non-group) market to accept everyone regardless of health status and prohibit premium surcharges for people with pre-existing health conditions. These rules should narrow the variation in how much people pay for insurance in different parts of the country, but premiums will likely continue to vary considerably due to differences in the cost of living in general and health care, in particular.