QUESTION

Can my insurer raise my premium if I’m unvaccinated?

Post enrollment issues | Individual Health Insurance Employer-Sponsored Coverage
ANSWER

It depends. If you are purchasing a plan in the individual market or through the health insurance marketplace, then the insurer is not permitted to increase your premium if you’re not vaccinated. However, if you obtain your coverage through your employer, they are permitted to establish financial incentives for plan enrollees to achieve certain health outcomes if they operate a workplace wellness program. Such incentives may include a premium surcharge of up to 30 percent of the total cost of coverage for a plan enrollee who fails to get the COVID-19 vaccine. (45 C.F.R. §147.102, 45 C.F.R. §146.121(f); CMS "FAQs about ACA, HIPAA and CARES Act Implementation," Oct. 4, 2021)

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