8/21/2025
How This Impacts Premiums
While this system is designed to promote fairness, it affects different age groups in very different ways:
- Younger, Healthier Individuals – Often pay significantly more than they would in states that allow age-based pricing, especially if they rarely use their coverage.
- Older Enrollees – May benefit from lower-than-average premiums compared to other states, since age is not a pricing factor.
The Upside
For older residents or those with health conditions, pure community rating can be a major financial relief. Premiums remain stable regardless of personal risk factors.
The Downside
For younger self-employed individuals, families, and healthy adults, this system can mean overpaying for coverage they rarely use. Without subsidies, the cost difference compared to other states can be significant.
Your Options
If you’re younger and healthy in a pure community rating state, it may be worth exploring off-marketplace plans that:
- Offer lower premiums
- Provide national PPO networks
- Allow more plan customization
Final Thought: Pure community rating has pros and cons, depending on where you fall in the age and health spectrum. Knowing how it works can help you make smarter decisions about your coverage.
Want to explore lower-cost options in a pure community rating state? Call (716) 503-1113 for a free plan review.