Health insurance declination rates, i.e. the percentage of applications rejected by insurers, remain a serious issue for U.S. consumers until 2014 when guaranteed issue protections are fully enacted. Hundreds of thousands of consumers have their health insurance applications declined each year according to a 2010 congressional study.1 A health insurance application rejection from one company can negatively affect applications with other companies since insurers typically ask about previous denials and take this information into consideration when evaluating the application.
Given that the criteria for declining applicants varies among insurers, HealthPocket analyzed more than 9,000 plans across the United States to determine the average declination rate of health insurance applications and compared this average to the declination rate of individual insurers. The results of this analysis demonstrated that there is little uniformity among insurance companies. Some insurance companies had state-level declination rates over 70% for the plans examined while other companies declined no applicants.2 Moreover, HealthPocket’s analysis revealed a nationwide application rejection rate exceeding one in five within the individual and family insurance market.3 This ratio is significantly higher than the findings of a 2010 congressional examination of the four largest for-profit health insurers where the rejection ratio was one in seven.4 What is unclear is whether some insurers have increased their declination rate to improve risk pool health and profitability prior to 2014 when insurance companies will no longer be permitted to deny health insurance on the basis of health status or pre-existing medical conditions. In this context it is important to note that there were also non-profit insurance companies with high declination rates. For example, Kaiser Permanente in Georgia had a declination rate of 34% while Humana, a large for-profit insurer in Georgia, had a declination rate of 23%. In Delaware, the non-profit Highmark had a declination rate of 42% for their individual and family health insurance plans.
The subject of individual insurance companies also raised the question of the consistency of declination rate within an insurance company. As mentioned earlier, Kaiser plans in Georgia had a declination rate of 34% but in Hawaii the same company had a much lower declination rate of 22%. This state-to-state variability in insurance company declination rates was seen across the market.
Focusing on declination averages within a state, the five insurance companies with the highest declination rates within the plans HealthPocket reviewed were as follows:
All companies in the list above (Assurant Health, Time Insurance Company, John Alden Life Insurance Company) belong to the Assurant Health group of companies.
Another interesting finding from the study was the difference in average declination rates among states. While the nationwide average was 22%, the state with the highest declination rate, Montana, was over twice that rate at 45%. In sharp contrast to Montana are states, such as New Jersey and New York, that have guaranteed issue regulations resulting in 0% declination rates. The data also revealed health plans with 0% declination rates outside guaranteed issue states.
To review declination rates for individual plans available in your area, HealthPocket’s individual and family health insurance comparison tool lists the declination rate for each plan on its Plan Details page.
Total U.S. Average: 22%Based on average declination rates for all plans, not weighted by state or by application volume
State Declination Averages
|Indiana||25%||New Mexico||30%||West Virginia||27%|
State with Highest Declination Rate: Montana 45%
States with 0% Declination Rates: Maine, Massachusetts, New Jersey, New York, and Vermont
Results of the study were based on an analysis of 9,450 health insurance plans for individuals and families under the age of 65. Plans from the Medicare, Medicaid, and employer-based health insurance markets were not included within this study. The data used in this study was obtained from insurance records made public by the Department of Health & Human Services. The data was collected in January 2013. All analysis assumes the accuracy of the underlying government data and does not include information on consumers who do not apply for health insurance because they suspect they would not satisfy applicant health criteria. While every effort was made towards a comprehensive collection of plans, HealthPocket makes no representation that every plan within the individual insurance market was included in this study. Percentages are rounded according to standard industry practices.
HealthPocket.com is a free website that compares and ranks all health plans available to an individual, family, or employer in a given area, all at once. The company uses only objective data from government, non-profit, and private sources that carry no conditions that might restrict the site from serving as an unbiased resource for consumers. The founders of HealthPocket.com spent decades pioneering online access to health insurance information and knew they could offer something different that can positively change how people use healthcare in the United States. Learn more at www.HealthPocket.com.
This study was completed by Kev Coleman, Head of Research & Data at HealthPocket.com. Correspondence regarding this study can be directed to Mr. Coleman at firstname.lastname@example.org.
Feedback and questions are welcome but, given the volume of email, personal responses may not be feasible.
1United States Congress. Coverage Denials for Pre-Existing Conditions in the Individual Health Insurance Market. House of Representatives Committee on Energy and Commerce memorandum. 111th Congress (October 12, 2010).
2The 0% apply to plans examined by HealthPocket. Even though an insurance application was not rejected there is still the possibility that a higher premium was offered to the applicant or other benefit restrictions due to a pre-existing health condition.
3This ratio is based on the average declination across the 9,450 health plans examined and is not weighted by plan enrollment distributions.4Coverage Denials for Pre-Existing Conditions in the Individual Health Insurance Market. p.1.
HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)