Carriers May Be Declining More Individual Application

Carriers are rejecting an average of 22% of applications for individual and family health plans, according to a study by HealthPocket. In comparison, a 2010 congressional study of the largest for-profit insurer found a decline rate of one in seven applications.

Kev Coleman, head of research & data at HealthPocket said, “Clearly there is great variability across states and within states, but nationally, it seems to be occurring more frequently than industry analysts had assumed. What is unclear is whether some insurers have increased their decline rate in order to improve risk pool health and profitability before 2014 when insurance companies can no longer reject applications based upon health status or pre-existing medical conditions.”

Some insurers decline more than 70% of applicants while others rarely decline applicants. There is also significant variability in different markets. For example, Kaiser Permanente plans have a decline rate of 34% in Georgia and a 22% in Hawaii. Some non-profit insurance companies have higher decline rates than do for-profit insurers.

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Last Updated 05/25/2022

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