The answer depends on whether we’re discussing the pre-underwriting price or the post-underwriting price.
By pre-underwriting price, I simply mean the monthly premium that you see posted on the internet etc without regard to one’s medical history. Only about 20% of all applicants can qualify for these “initial” or “preferred rates”. Everyone else will be rated up over and above the preferred rates.
The factors that determine an initial or preferred rate quote for health insurance are as follows: 1) Your home zip code 2) Whether you use tobacco or not 3) Birthdays of all to be insured. That’s it, but remember that only 20% of you will qualify for this rate.
The other 80% of all applicants will be rated up based on a number of factors. These can include the following:
1) Medications – Insurance carriers will factor in the cost of medications taken within the last 2 years into their final offer. The more expensive the medication, the higher the final premium. Not all medications matter though. Certain prescriptions that are taken just once (ie. an antibiotic for a chest cold) will generally have little to no effect on the final offer. A maintenance medication (ie. Lipitor for elevated cholesterol) can have a significant impact on the final offer since it’s quite expensive and must be taken every month to be effective.
2) Medical history – The Texas health insurance carriers can and will also use your medical history within the last 10 years to determine what type of risk you are to the carrier much in the same way that an auto insurance carrier will use your driving record t determine how risky you are. If you had an appendectomy 3 years ago, that will have little to no affect on the final rate since that is a very simple surgery with almost no further treatment required beyond the procedure itself. However, if you had surgery to remove colon cancer 3 years ago, that’s a completely different story. That type of condition carries a much higher risk of reoccurring and therefore the insurance carrier will increase your monthly premiums, fairly significantly, to recoup some risk associated with insuring you.
3) DUIs and alcohol/drug abuse and treatment – A person with a DUI within the last 5 years will almost always pay a higher monthly premium on their health insurance vs. someone who hasn’t had one. Same goes with someone who has a history of drug/alcohol abuse. It’s a fact that people with alcohol/drug abuse in their history generally cost much more to insure than those who do not because they tend to develop more health issues over time. In general, those people tend to not take care of their health as they should by making poor lifestyle choices (poor diet, lack of exercise, excessive drinking, tobacco use etc)
There are many other factors that will cause an insurance carrier to determine your final rate, so these are just a few to be aware of. If you are curious as how you would be rated or which insurance carrier would be best in your given situation, just contact us at www.selectedbenefits.com or call us at 866.270.6209.