Under the ACA, how are premiums determined with respect to health status and age?

• A. Premiums vary only by tobacco use.
• B. Premiums are the same for all ages and health statuses with no variation.
• C. Under ACA, premiums are determined primarily by community rating with limited age-based differences, rather than by individual health status.
• D. Premiums are based solely on income.

Answer: (C)

Under the ACA, premiums are determined using adjusted community rating: insurers set prices based on the average risk of the market, not on an individual’s health. Health status cannot be used to charge higher premiums or deny coverage. Age does matter, but with limited differences within a defined ratio, and premiums can also vary by geographic area and tobacco use. Subsidies may reduce what you pay, but base premium levels aren’t driven by income alone. So, premiums determined primarily by community rating with limited age-based differences, rather than by individual health status, is the best description.