re: .

quote:

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Let's take a harder example. A person has tons of health problems growing up while on parents' insurance plan. Comes of age and has to get own coverage. Insurer says their coverage will be 5 times the average, making it impossible to afford.

Should there be a provision for that situation or is that person just SOL?

Honestly just curious.

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Not a great example honestly. In the insurance world, companies have look back periods, and specifically to P&C insurance world, they have CLUE reports. It's basically an underwriter looking at claims that have been made over the past 2, 5, 10 or however many years. In the life world, they look at Rx history and information from the Medical Information Board for however many look back years they use. Health Insurers cannot do this.

Generally, insurance companies set rates based on the likelihood they will have to pay a covered loss. So yes, if someone has been to the ER 7 times in the past 5 years, he should pay more for health insurance than someone of the same age/gender who has not been.

The best way to prevent this person from having rates 5x the average is to let the Insurance Companies establish huge homogeneous groups of people like your example so they can collectively pay less rates together.

Obamacare prevents this.