Is Your State Protecting You?

Oversight of the health insurance industry, particularly the individual and small group markets, is left mostly to the states.

Families USA conducted a 50-state survey of insurance commissioners, focusing on states’ regulatory oversight of the individual health insurance market. Families USA asserts “that market is increasingly important as employer-sponsored health insurance declines and some elected officials promote its deregulated expansion.” The key findings of the survey include:

• Only five states prohibit insurance companies from “cherry-picking” the healthiest consumers and excluding everyone else from coverage.


• In 35 states and the District of Columbia, there are no limits on how much insurers can raise premiums based on an individual’s health status. An additional six states have limits that still allow dramatic variations in premiums.


• In 21 states and the District of Columbia, insurers can exclude coverage for pre-existing conditions, such as cancer and heart ailments, for more than one year.


• In 44 states and the District of Columbia, insurers can revoke an individual’s health insurance policy without advance review by the state.


• In 29 states and the District of Columbia, insurers are allowed to deny legitimate claims of policyholders who are up-to-date with their premium payments by digging back years into their medical history and alleging that they failed to disclose, or should have known about, a pre-existing condition.


• In 45 states and the District of Columbia, insurers do not have to spend at least 75 percent of premium revenues on health care, which allows insurers to retain those revenues for profits and non-health care expenses (such as marketing).


• In 20 states and the District of Columbia, insurers can set and raise premiums without meaningful oversight.

Learn how well your state is protecting you.