Shopping for healthcare can be time-consuming and feel overwhelming. And one frustrating part can be figuring out what health insurance might cost.

“There’s no one-size-fits-all answer when it comes to health insurance prices,” says Brett Casey, a licensed insurance agent with HealthMarkets in Oklahoma City.

But there are basic guidelines you can follow to help give you an idea of health insurance costs—and allow you to make an informed decision on your own.

Get in touch with a HealthMarkets licensed insurance agent at (800) 304-3414, or visit healthmarkets.com.

Factors That Affect Health Insurance Cost

The cost of individual health insurance varies, but a few key factors influence how much you’ll pay, says Casey. They include:

  • Your age: Premiums can be up to 3 times higher for older adults than for younger ones.
  • Your income: If you’re shopping for health insurance on the Affordable Care Act (ACA) Health Insurance Marketplace and your income falls below a certain level, you may qualify for extra savings known as cost-sharing reductions (CSRs).

With a CSR,  you’ll pay less out of pocket each time you get medical services. You’ll also have a lower deductible (what you pay before your health insurance kicks in), lower copayments (the flat fee you pay for a covered service) or coinsurance (the percentage you pay for a covered service), and a lower out-of-pocket maximum.

However, you must choose a silver ACA plan to get these benefits. Silver plans are the most popular, and they tend to have moderate monthly premiums and costs when you need care. (ACA marketplace plans are categorized by metal levels: bronze, silver, gold, and platinum.)

  • Where you live: Location matters when it comes to health insurance. Costs vary by state, depending on everything from competition among healthcare companies to state regulations and how much it costs to live there.
  • Number of people in your household: It makes sense that the more people you have on your health plan, the more you’ll pay for it. But depending on your income level and household size, you may be eligible for a premium tax credit, which can lower you monthly the monthly premiums for an ACA plan. Unlike cost-sharing reductions, a premium tax credit can be used with any metal level plan.
  • Whether you use tobacco: Thinking about quitting smoking? Insurance companies can charge tobacco users up to 50% more than those who don’t use tobacco.

Decisions That Affect Health Insurance Cost

There’s not much you can do to change the factors that raise your premiums. But one thing you can do is figure out which metal plan in the ACA marketplace works best for you, says Casey. Each metal represents how you and your insurance company will share insurance costs—though all of these plans cover preventive services at no additional cost to you.

Here’s a quick look:

  • Bronze
    Insurance company pays: 60% of total yearly costs of your care
    You pay: 40%

A lower-costing bronze plan is a way to protect yourself in emergencies, and may be a good choice if you are in very good health and see the doctor infrequently. Your monthly premium may be low, but you may have to pay a lot before meeting your deductible.

  • Silver
    Insurance company pays: 70% of total yearly costs of your care
    You pay: 30%

If you qualify for cost-sharing reductions, this is could be the best plan to choose. It could save money each year, especially if you use a lot of care. You’ll most likely pay a higher monthly premium than a bronze plan, but you’ll pay a lower percentage of the out-of-pocket costs when receiving care.

  • Gold
    Insurance company pays: 80% of total yearly costs of your care
    You pay: 20%

Gold plans usually have a high monthly premium, but if you expect to need a lot of care throughout the year, it may still end up being the best value.

  • Platinum  
    Insurance company pays: 90% of total yearly costs of your care
    You pay: 10%

Platinum plans will most likely have the highest monthly premium but the lowest deductible. In other words, you’ll pay the more per month for your insurance, but it means your insurance will start paying for your out-of-pocket costs sooner when receiving your care.

You should also look at what prescription medications you take. “If you take only generics, they will most likely be affordable on any plan,” says Casey. “But if you take brand-name medications that are expensive, if a higher-tier plan has more generous coverage it might be a better choice.”

Now, if you’re under age 30, you may be eligible for what’s known as a catastrophic plan. These plans have super low premiums but high deductibles. Case in point: In 2020, the deductible for catastrophic plans was $8,150. But after you meet that deductible, your insurance company will pay for all covered services. In short, you won’t have any copayment or coinsurance.

Looking to compare health insurance plans? Contact a HealthMarkets licensed insurance agent at (800) 304-3414, or visit healthmarkets.com to get started.

What Type of Plan Should I Buy?

Deciding what type of insurance plan you need to buy can get confusing, so here’s a quick guide:

Exclusive Provider Organization (EPO): Services are covered only if you use doctors, specialists, or hospitals in the plan’s network, except in an emergency.

Health Maintenance Organization (HMO): Coverage is limited to doctors who work for or contract with the HMO. Generally, there’s no coverage for out-of-network care except in an emergency.

Point of Service (POS): You pay less if you use doctors, hospitals, and other healthcare providers that belong to the plan’s network. You need a referral from your primary care doctor to see a specialist.

Preferred Provider Organization (PPO): You pay less if you use providers in the plan’s network, but you can go out of network without a referral for an additional cost.

Which type of plan you choose will depend on where you live and what your healthcare needs are.

“The larger the provider network, the higher the cost, but you may need that if you have pre-existing health conditions and anticipate a lot of medical care,” explains Casey.

The Bottom Line

The easiest way to figure out how much basic health insurance costs, besides doing it yourself, is to simply request a quote from a licensed healthcare agent.

“We take the time to take a thorough family history to find out if you’re at risk for certain diseases, learn what prescriptions you take and what doctors you prefer to see,” says Casey. “All of these help us do an analysis and look at every company that’s out there to figure out which plan might be the best for you.”

Need to get in touch with a licensed insurance agent to talk about health benefits? Contact a licensed HealthMarkets agent at (800) 304-3414, or visit healthmarkets.com.

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References

Healthcare.gov Retrieved from https://www.healthcare.gov/how-plans-set-your-premiums/ Accessed December 27, 2021.
Healthcare.gov Retrieved from https://www.healthcare.gov/lower-costs/qualifying-for-lower-costs/ Accessed December 27, 2021.
Healthcare.gov Retrieved from https://www.healthcare.gov/choose-a-plan/plans-categories/ Accessed December 27, 2021.
Healthcare.gov Retrieved from https://www.healthcare.gov/choose-a-plan/catastrophic-health-plans/ Accessed December 27, 2021.

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