Rate Review

The Rate Review program in your state helps protect individuals and small businesses from unreasonable health insurance rate increases. Under this program, health insurers generally must justify rate increases of 10 percent or more in the individual or small group market before the increase takes effect.

What This Means for You

  • Your insurance company generally can’t raise rates by 10 percent or more for coverage in the individual or small group markets without first explaining its reasons to your state and/or federal regulators.
  • Your Rate Review program will determine if the rate increase is unreasonable. A rate hike is unreasonable if, for example:
    • It is based on faulty assumptions or unsubstantiated trends.
    • It charges different prices to people who pose similar risks to the insurer.
  • Your state regulator can approve or reject an unreasonable or excessive rate increase, if your state laws give the regulator this authority.

Some Important Details

  • These requirements don’t apply to certain individual and small group health plans that were in place when the Affordable Care Act was enacted that have not been changed in certain ways (grandfathered plans) or to large group health plans.
  • Each state is permitted to request its own State specific minimum premium increase that requires a review, based on the state’s unique premium trends, health care cost trends, and other factors.
  • If your state doesn’t have a Rate Review program, or has a Rate Review program that is determined to be ineffective, the federal government conducts the Rate Reviews for coverage subject to these Affordable Care Act consumer protections.

For More Information

Content created by Assist. Sec./Public Affairs - Digital Communications Division
Content last reviewed on January 26, 2015