Skip to Main Content
 

The Center for Consumer Information & Insurance Oversight

 

Market Rating Reforms

State Specific Rating Variations

The Market Rules and Rate Review Final Rule (45 CFR Part 147) provides that each state will have age rating ratios of 3:1 using a federally established age curve, tobacco rating ratios of no more than 1.5:1 and per member rating unless a state requests ratios less than the standard, is a community rating state with uniform family tiers, or allows for averaging of enrollee premiums in the small group market.

The Protecting Affordable Coverage for Employees Act (Pub. L. 114-60) amended the definition of small employer in section 1304(b) of the Affordable Care Act and section 2791(e) of the Public Health Service Act to mean generally an employer with 1-50 employees, with the option for states to expand the definition of small employer to 1-100 employees.

The table below includes only states that have implemented standards other than the federal defaults.  If a cell is blank or a state is not listed, the federal default applies. Please scroll down for more specific information on:

Updated June 2, 2017

 

  Individual Market Small Group Market
State Age Rating Ratio State-Established Age Curve Tobacco Rating Ratio Uniform Family Tiers Age Rating Ratio State-Established Age Curve Tobacco Rating Ratio Uniform Family Tiers Average Enrollee Premiums1 State-Specific Composite Premium Method2 State expanded definition of small employer3
Alabama   Yes               Yes  
Alaska                   Yes  
Arizona                   Yes  
Arkansas     1.2:1       1.2:1     Yes  
California     1:1       1:1       Yes
Colorado     1.15:1       1.15:1     Yes Yes
Connecticut     1.5:1       1:1        
Delaware                 Yes    
District of Columbia   Yes 1:1     Yes 1:1    Yes    
Florida                   Yes  
Georgia                   Yes  
Hawaii                   Yes  
Idaho                   Yes  
Illinois                   Yes  
Indiana                   Yes  
Iowa                   Yes  
Kansas                      
Kentucky     1.4:1       1.4:1        
Louisiana                   Yes  
Maine                   Yes  
Maryland                   Yes  
Massachusetts 2.1 Yes 1:1   2.1 Yes 1:1     Yes  
Michigan                      
Minnesota   Yes       Yes          
Mississippi   Yes        Yes           
Missouri                      
Montana                   Yes  
Nebraska                   Yes  
Nevada                      
New Hampshire                      
New Jersey     1:1   1.824:1* Yes  1:1        
New Mexico                      
New York 1:1   1:1 Yes 1:1   1:1 Yes     Yes
North Carolina             1.2:1        
North Dakota                      
Ohio                      
Oklahoma                      
Oregon   Yes      3:1** Yes  1.5:1**   Yes Yes  
Pennsylvania                      
Rhode Island     1:1       1:1   Yes    
South Carolina                      
South Dakota                   Yes  
Tennessee                   Yes  
Texas                   Yes  
Utah   Yes       Yes       Yes  
Vermont 1:1   1:1 Yes 1:1   1:1 Yes     Yes
Virginia                   Yes  
Washington                      
West Virginia                      
Wisconsin                      
Wyoming                      

* Overall 2:1 variation for small groups: NJSA 17B:27A-25.
**Overall 3:1 variation for small groups: ORS 743.737(11).

1 Average Enrollee Premiums: the state requires that all issuers use a composite premium methodology to bill consumers instead of a per-member only billing methodology.  Unless the state has a CMS-approved state-specific alternative composite premium methodology, for plan years beginning on or after January 1, 2015, issuers in the state must composite using the federal default method of two tiers: one tier for all adults and a second tier for all children under 21.  

2 State-Specific Composite Premium Method: the state has received authorization from CMS to require that all issuers use an alternative method to the federal default method using two tiers.  In a state that has an approved alternate composite premium method, issuers that offer composite premiums in addition to per-member premiums must use the state-specific method when compositing premiums. If the state requires composite premiums, the state-specific composite premium method is the only billing method allowed. Employers and issuers in states with an approved alternate composite premium method should check with the state department of insurance to assure understanding of the alternate composite method.

3 State has notified CMS that it will expand the definition of small employer from 1-50 employees to 1-100 employees.

 

State Specific Age Curve Variations

2017 State Specific Age Curve Variations 8-9-2013 [PDF, 147KB]  

2018 State Specific Age Curve Variations 5-31-2017 [PDF, 316KB]  

State Specific Family Tier Ratios

 

State One Adult Two Adults One Adult and One or More Children Two Adults and One or More Children
New York 1 2 1.7 2.85
Vermont 1 2 1.93 2.81
 
.