For Consumers

How my premiums are determined

How much you pay for your monthly premium depends on the company rate we approve. We review all rate requests for individual and small group health plans (employers with 1 to 50 employees) in Washington state, either approving or denying the insurers' requests. Health insurance companies can't change rates more than once a year, unless state or federal law requires a new health benefit.

Factors that affect premiums

How much you pay for your premium depends on:

  • Your age and the age of any family members in your plan
  • Your family size
  • Whether or not you smoke
  • Where you live
  • The type of plan you choose

Why premiums increase

Individual and small group health insurance rates are community rated. This means the rates are based on the combined claims everyone files. This is why your premium may go up even if you haven't filed a claim. Also, the rising cost of medical care impacts rates.

How we review health rates