HOW DOES IT PROTECT HIGH-RISK INDIVIDUALS? The amendment’s limited waiver for health rating requires states to set up a program for high-risk individuals or premium stabilization, or to participate in the federal invisible risk-sharing program. No state may obtain a waiver for health status unless it has taken these efforts to protect those who might be affected. In states with a waiver, individuals who maintain continuous coverage could not be rated based on health status.
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Importantly, these higher premiums could only be charged for a period of one year to an individual who did not maintain continuous coverage. After an individual has maintained continuous coverage for twelve months they would then return to standard rates. This means that the protections against being charged higher premiums for a health condition are preserved for every individual market plan holder who maintains continuous coverage.