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community rating

What is community rating?

Community rating refers to an insurance pricing system that prohibits medical underwriting and requires that all of a carrier’s insureds in the same geographical area pay the same premiums, regardless of their health status.

Pure community rating means that age and gender are also not used to determine premiums. Since 2014, modified community rating has been used in the individual health insurance market: Medical underwriting is no longer be allowed, but there is some variation in premiums based on age. (Premiums will be up to three times higher for older applicants – in some states, the current pricing model allows for significantly higher ratios than this.) Tobacco users will still pay more for their health insurance.