Document Type

Policy Brief

Publication Date



Access/Insurance, insurance, rural, ACA, MRHRC


This brief examines how and to what extent states allow health plans to vary premiums by geographic rating area and, using insurance data from selected states, assesses the direction and magnitude of variations in rural and urban geographic rating factors. The authors conclude with a discussion of strategies that federal and state policymakers might use to help ensure that premium variations based on geography are justified. KEY POINTS: There is no clear pattern of geographic rating factors favoring rural or urban areas. This lack of a clear pattern suggests that health plans may use geographic rating for business purposes other than adjusting for underlying cost/price differences. Geographic rating could reduce insurance risk pooling and be used as a proxy for experience rating. To limit the effect of market segmentation resulting from geographic rating, rate bands could be imposed on area rating factors.


The State Health Access Reform Evaluation (SHARE) is a Robert Wood Johnson Foundation (RWJF) program that aims to provide evidence to policy makers on specific mechanisms that contribute to successful state health reform efforts. The program operates out of the State Health Access Data Assistance Center (SHADAC), an RWJF-funded research center in the Division of Health Policy and Management, School of Public Health, University of Minnesota. Information is available at



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