Does the Number of Times You See a Doctor Affect Your Health Insurance Premium?

Insurance is a double-edged sword. With health insurance, you need to use it to stay healthy. In fact, using it for regular, routine care can help you avoid more costly health expenses that could cause you to be denied coverage in the future. And using it for routine care won't increase your premiums because this type of usage has already been factored into the rates you're paying. It's only when your usage falls outside of the norms for your classification groups that you risk increased premiums.

External Factor in Premiums

• A number of factors are used to determine your health insurance premiums, which allows you to use the insurance without the premium increasing in most instances. Some of the things that will affect your premium have nothing to do with health. Where you live affects your premium because some areas are considered healthier places to live than others, and different states may require different types of coverage be provided.

Health Factors in Premiums

• Other factors that determine your premium are health-related. If you score on the healthy side for these factors, then your premium is lower. Smokers can pay up to 27 percent more on their premiums, according to Health Insurance Medics. A high body mass index indicate potential health problems and so rate higher premiums. Older people tend to use health insurance more, so they are charged more. Because women tend to use health services more to care for themselves, they are charged slightly higher rates.

Managing Risk

• As you can see with some of the risk factors, those who use health insurance more, on average, are charged more. While you as an individual may not use it more than a lower-risk individual, odds are that you will and so it is taken into account when you purchase your health insurance. This is how the insurance company manages risk. It analyzes groups and make generalization about the group. If you are in the high-risk group you are charged more not because you use your insurance more, but because your group does.

Average Risk

• The information to make these generalizations is drawn from information provided by actuaries who compile the statistical data that show relationships between the group and the use of insurance. The insurance company then sets premiums based on the group's usage of the insurance so that it will collect enough to cover any potential losses. For an insurance company, analyzing larger groups has proven to be more accurate than setting a premium based on the individual.

Group Policies

• The difference between group policies and individual ones lies in the group that is used to determine rates. Group policies use an employment group's health history to determine rates. This takes into account a variety of individual groups that each member of the employment group represents. It also means that any heavy use of health insurance in a small company will affect rates more than with larger companies. For instance, if an employee undergoes cancer therapy in a company of 50, the increased costs in the premiums will be greater than in a company of 500 because the risk can't be averaged over smaller company insurance participants as well. However, normal health insurance usage will have little or no effect on group policy rates.