Average Health Insurance Rates By Age | SmartFinancial (2023)

Older people pay higher health insurance premiums than younger people because they are more likely to require medical care that is more frequent and costly. Insurance premiums for a 21-year-old consumer serves as the base rate for other age groups — younger people have a lower rate multiplier (lower premiums), while older people have higher rate multipliers (higher premiums).

Find out how your age multiplier compares to other age groups.

Does Age Affect My Health Insurance Rates?

Age is one of several factors insurers use when calculating your health insurance premium. Rates tend to increase with age because people typically develop health conditions as they grow older. Compared to somebody young and healthy, an elderly person with health conditions typically needs more medical attention and is more likely to file health insurance claims.

However, there is a cap on how much older people can be charged versus younger people based on age. Insurers can charge older people up to three times the rate for a 21-year-old when factoring age. However, actual premiums can vary significantly based on other rating factors, such as smoking and plan type.

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Average Health Insurance Rates by Age

Most states use age 21 as a base rate and then apply a multiplier based on the individual’s age. Rates are generally cheaper for individuals 20 years and younger and higher for ages 22 and up. The premium multiplier is capped at 3.00 for older people — older individuals will not pay more than three times the rate paid by a 21-year-old based on age alone.

Health insurance rates tend to increase with age because people typically develop health conditions as they grow older.

The table below shows premium multipliers by age plus sample average health insurance premiums for Silver and Platinum health plans. (Note: Sample premiums will not perfectly reflect the age premium multiplier, since geography, tobacco use, income level and other rating factors are used).

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Do Some States Consider My Age Differently When Setting Rates?

Some states use their own age premium multiplier standard when determining the cost of health insurance. Below, we compare standards in these states to the federal standard.

Utah rate multipliers are lower from ages 15 to 20 but scale more quickly than the federal rating system for 22 and up. For example, the rate multiplier for age 30 is 1.39 in Utah versus 1.14 for the federal system. The 3.00 rate cap is also applied earlier at age 59 instead of 64.

Oregon, Mississippi, Minnesota and Alabama do not follow the federal rating factors for ages zero to 20. Rate multipliers are lower in Oregon, Mississippi and Alabama. For Minnesota, the rate is higher for ages zero to 17 but cheaper for ages 18 to 20. These four states follow the federal standard for ages 21 and up.

Massachusetts has lower rate multipliers from ages 0 to 20 but becomes higher from ages 21 to 48. It then scales lower than the federal standard starting at 49 and caps at 2.37 at age 60.

Washington, D.C. has rate multipliers lower across all ages. The rate cap is also lower (2.18) and occurs earlier than federal standard (age 61).

Age Is Only One of Several Rating Factors

Besides age, insurers may use the following when calculating health insurance costs:

• Location: Pricing for medical products and services can vary by state and even city, leading to different health insurance costs by geography.
• Tobacco use: Smokers can pay up to 50% more than those who do not smoke according to the U.S. Centers for Medicare & Medicaid Services (CMS).
• Individual vs. family enrollment: Adding dependents, like children, can increase the cost of health insurance.
• Plan category: Healthcare plans have five categories (Bronze, Silver, Gold, Platinum and Catastrophic). These plans indicate how high your monthly premium is versus your out-of-pocket costs (e.g., deductible, copay) — not the quality of medical service. Bronze plans typically have the lowest monthly premiums, but high deductibles.
• Health insurance company: Different health insurance companies offer different plans and prices.
• Type of plan: Different types of policies, such as EPO, PPO or HMO, carry different costs and deductibles.

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What Health Insurance Options Do I Have if I’m Under 26?

Consumers under age 26 can stay on their parent’s health insurance plan or obtain coverage through their school, employer or the marketplace.

Stay on Your Parents’ Health Insurance Plan

The 2010 Affordable Care Act requires insurers to offer dependent child coverage to parents until the child turns 26. This offer must remain in effect even if the child gets married or has healthcare coverage options from their employer.

Enroll in a Student Health Insurance Plan

Students can speak with their college or university counselor to learn about available health insurance plans and pricing. Costs can be relatively affordable since the plans serve college students who may not yet be financially independent.

Enroll in Your Employer’s Health Insurance Plan

If your employer offers group health coverage, you may want to sign up after joining the company or during open enrollment. Some employers subsidize some or all of the cost of healthcare, which means more savings in your pocket.

Buy a Plan From the Health Insurance Marketplace

People under age 26 can enroll in a private health insurance plan by shopping on the health insurance marketplace. The marketplace is run by the federal government and requires all plans to cover 10 essential health benefits:

• Ambulatory patient services
• Emergency services
• Hospitalization
• Pregnancy, maternity, and newborn care
• Mental health and substance use disorder services (e.g., counseling, psychotherapy)
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services

Keep in mind that adult dental and vision coverage are not essential health benefits and you may need to purchase these coverages as a policy add-on or a separate plan.

What Health Insurance Options Do I Have if I Am 65 Or Older?

Several health insurance options are available to older U.S. citizens, including Medicare, Medicaid, employer insurance and more.

Enroll in Medicare

Medicare is government-funded health coverage available to U.S. citizens ages 65 and older or with a qualifying disability. Medicare Part A (hospital insurance) has a zero premium if you’ve paid Medicare taxes for at least 10 years, but there will be costs with other Medicare parts (e.g., doctor services, prescription drugs).

You can obtain Medicare coverage via two methods:

• Original Medicare: Gain Medicare Part A (hospital insurance) and Part B (doctor/medical insurance). Prescription drug coverage and Medicare Supplement plans (covers out-of-pocket costs) are available as an add-on cost, as well.
• Medicare Advantage (MA): Also called Medicare part C, MA plans bundle different types of Medicare coverage and are sold by private insurance companies. MA Plans may have benefits excluded by Original Medicare, such as vision and dental coverage.

Enroll in Medicaid (If You’re Low-Income)

Medicaid is a state and federal insurance program that provides health coverage to low-income families. Other qualified groups, such as pregnant women and children in foster care may be eligible to enroll, as well.

To qualify for Medicaid, you will need to meet certain income thresholds that will vary by state. Medi-Cal (California’s Medicaid program), for example, sets maximum income levels based on household size.

Qualified individuals may be enrolled in both Medicare and Medicaid. These people are called “dual eligibles.” Dual eligibles may still want to pay for additional coverages, like Medicare Part D to cover the cost of prescription drugs.

Stay on Your Employer Health Insurance Plan

If you’re insured through your employer’s group health plan, you do not leave it to enroll in Medicare. You can have both Medicare and employer insurance or wait until you retire before enrolling in Medicare.

Keep in mind that Medicare Part B may charge a late penalty if you sign up later depending on the size of your employer. Before delaying Medicare enrollment, you should talk to your HR department or whoever administers the plan to confirm this information.

Buy a Plan From the Health Insurance Marketplace

Outside of government-funded health or employer healthcare plans, you can buy a private plan on the health insurance marketplace. Open enrollment for 2022 has already ended but you be able to qualify for a Special Enrollment period if you’ve experienced a qualifying life event, such as:

• Getting married
• Having a baby or adopting a child
• Getting divorced or legally separated
• Moved to a new zip code or country
• You or anyone in your household lost qualifying health coverage

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Besides age, insurers will consider other factors, like smoking and location, when calculating health insurance costs.

Find cheap health coverage at any age. Whether you’re young or old, health insurance can help you pay for the medical services you need to maintain or improve your health. SmartFinancial analyzes carriers in your area to bring you the health coverage you need at the cheap price you want. Just enter your zip code below or call 855.214.2291 to receive your free health insurance quotes.

Methodology

SmartFinancial used the most recent information from the Centers for Medicare & Medicaid Services to compile age rating multipliers.

Sample health insurance rates were generated from Healthcare.gov. Our sample applicant was male, lived in Florida, made $60,000 annually and did not use tobacco. The plan categories uses (Silver and Platinum) use the below definitions and are not indicative of service quality:

• Silver: Compared to bronze, has higher monthly premium, but lower deductible
• Platinum: Has highest monthly premium, but extremely low deductible that should cover nearly all your healthcare costs