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Selecting the best health insurance plan can feel overwhelming. If you aren’t eligible for employer-sponsored health insurance, you can buy a plan through the Affordable Care Act (ACA) marketplace at Healthcare.gov, which lets you compare plans available in your area.
The ACA also allows you to compare multiple health insurance quotes so you can select the health plan that works for you.
How Much Does Health Insurance Cost?
The average monthly cost of health insurance for a silver plan on the ACA marketplace is $397 for individual unsubsidized coverage for a 21-year-old person, $419 for a 27-year-old, $453 for a 30-year-old, $509 for a 40-year-old, $712 for a 50-year-old and $1,079 for a 60-year-old.
Health insurance companies base ACA marketplace plan rates on multiple factors, including:
- Your state and age
- Your smoking status
- The type of health plan
- The metal tier
- How many people you’ll have on the health plan
The health insurance marketplace is different from group health insurance provided by employers. Those plans don’t consider your age when setting rates.
Featured Health Insurance Partners
1
Aetna
Coverage area
Offers plans in all 50 states and Washington, D.C.
Number of providers in network
About 1.2 million
Physician copays start at
$20
2
Blue Cross Blue Shield
Coverage area:
Offers plans in all 50 states and Washington, D.C.
Number of providers in network
About 1.7 million
Physician copays start at
$10
3
Cigna
Coverage area
Offers plans in all 50 states and Washington, D.C.
Number of providers in network
About 1.5 million
Physician copays start at
$0
Compare Health Insurance by Plan Level, Metal Tier, Age, Company
The cost of health insurance on the ACA marketplace varies based on multiple factors. Let’s take a look at average costs using some of those factors.
Average Costs by Health Insurance Plan
The health plan’s benefit design dictates things like whether you can get out-of-network care and whether you need referrals to see specialists. It also influences your costs.
Average monthly cost for HMO | Average monthly cost for EPO | Average monthly cost for PPO | ||
---|---|---|---|---|
$480 | $524 | $576 | ||
Source: Healthcare.gov. Average costs are for a 40-year-old. Based on unsubsidized ACA plans. |
Average Costs by Metal Tier
Premiums and out-of-pocket costs decide an ACA plan’s metal tier. If you’re looking for affordable health insurance going with a bronze plan with lower premiums but higher out-of-pocket costs when you need care might be your best bet.
Average monthly costs for bronze plan | Average monthly costs for silver plan | Average monthly costs for gold plan | ||
---|---|---|---|---|
$420 | $549 | $713 | ||
Source: Healthcare.gov. Costs are for a 40-year-old. Based on unsubsidized ACA plans. Note: Platinum plans aren’t usually offered and we don’t have enough cost data on those types of plans to offer an accurate picture of costs. |
Average Health Insurance Costs by Age
Your age is one of the most important factors that dictate your health insurance costs on the health insurance marketplace. The ACA marketplace is the only place where standard health insurance uses age to set rates. Employer plans, which is how most pre-retirement age Americans get coverage, does not use age as a factor.
Age of member | Average monthly costs | |
---|---|---|
Age 21 | $397 | |
Age 27 | $419 | |
Age 30 | $453 | |
Age 40 | $509 | |
Age 50 | $712 | |
Age 60 | $1,079 | |
Source: Healthcare.gov. Based on unsubsidized ACA plans. |
Average Health Insurance Costs by Company
Obamacare costs differ by company, so it’s wise to compare costs for multiple plans before choosing an ACA plan.
Health insurance company | Average monthly cost for a 40-year-old | |
---|---|---|
Kaiser Permanente | $445 | |
Oscar Health | $459 | |
Aetna | $466 | |
Cigna | $504 | |
UnitedHealthcare | $506 | |
Blue Cross Blue Shield | $569 | |
Source: Healthcare.gov. Costs are for a silver plan. Based on unsubsidized ACA plans. |
How to Compare Health Insurance Quotes and Plans
Compare health insurance premiums, out-of-pocket costs like deductibles and coinsurance and the plans’ benefit designs and provider network when figuring out which ACA plan to choose.
Premiums, which you pay for health insurance coverage, are one important factor, but don’t forget to review deductibles, coinsurance and copays, too. Those costs are factored in whether an ACA plan is bronze, silver, gold or platinum. The ACA marketplace lets you compare all of those cost factors.
Here are questions you may want answered when you’re requesting a health insurance quote:
- Types of Plans
- Metal Tiers
- HDHP and HSA
- Deductibles and Out-of-Pocket Costs
- Medication Coverage
- Out-of-Network Coverage
- Referrals
Types of Plans
The type of plan you choose dictates the flexibility of your health insurance. Some plans allow you to see almost any doctor, while others restrict your options to only in-network providers. Plans vary in cost as well. There are four basic types of health care plan benefit designs: HMO, PPO, POS and EPO.
Benefit design reflects whether the plan allows out-of-network care, requires members to choose a primary care provider and mandates if members need referrals to see specialists. A plan’s benefit design influences not only how much your health plan flexibility but also how much you pay for out-of-network services.
Benefit Design Comparison
Plan type | Out-of-network coverage? | Need referral for specialists? | Cost |
---|---|---|---|
EPO: Exclusive provider organization | No | No | More expensive than HMOs but less expensive than PPO premiums generally |
HMO: Health maintenance organization | No | Yes | Least expensive |
POS: Point of service | Yes | Yes | More expensive than HMOs but less expensive than PPOs typically |
PPO: Preferred provider organization | Yes | No | Most expensive |
Metal Tiers
Health plans in the ACA exchange are organized into four metal tiers based on costs:
- Bronze and silver plans typically have the lowest premiums.
- Gold and platinum plans have higher premiums.
- However, bronze and silver plans have higher out-of-pocket costs than gold or silver plans when you need care.
You shouldn’t choose a health care plan solely on premiums. Out-of-pocket costs also play a vital role in overall health expenses. Out-of-pocket costs, including health insurance deductibles and coinsurance, are what you pay when you need health care services. Gold and platinum plans have the lowest out-of-pocket costs, so you’ll pay less when you need care with those plans rather than bronze or silver plans.
A marketplace plan’s metal tier only helps you figure out health care costs. It doesn’t take into account the plan’s benefit design.
Metal Tier Comparison
Type of metal tier | Premiums | Deductibles | Coinsurance levels |
---|---|---|---|
Bronze | Cheapest | Highest | 40% |
Silver | More expensive than bronze | Not as high as bronze | 30% |
Gold | Less expensive than platinum | Higher than platinum | 20% |
Platinum | Most expensive | Lowest | 10% |
HDHP and HSA
One lower-cost option is a high-deductible health plan (HDHP), which has lower monthly premiums but higher out-of-pocket costs. Bronze and silver plans may be considered HDHPs on the ACA marketplace.
The Internal Revenue Service (IRS) defines an HDHP as any plan with:
- A deductible of at least $1,600 for an individual or $3,200 for a family.
- Annual in-network out-of-pocket expenses (such as deductibles and copayments) can’t exceed more than $8,050 for an individual or $16,100 for a family.
Having an HDHP means you’re eligible for a health savings account (HSA). HSAs are accounts that you use to pay for eligible healthcare costs. You put in the money tax-free, take it out tax-free and get the compounded growth tax-fee.
HSA funds rollover into the next year, so they don’t have use-it-or-lose-it restrictions like a flexible spending account. That’s just one of the differences between FSAs and HSAs.
Deductibles and Out-of-Pocket Costs
A health insurance deductible is the amount you pay for health care services annually before your health insurance plan begins to kick in money.
Once you reach your plan’s deductible, you typically reach the coinsurance portion of your health plan. With coinsurance, you and the health plan pay a percentage for healthcare services. If your health plan has a 30% coinsurance level, you pay 30% of the healthcare services bill and the insurer pays the other 70%. You pay coinsurance until you reach your plan’s annual out-of-pocket maximum.
Out-of-pocket costs refer to the patient’s personal costs associated with healthcare. Your plan’s deductible and coinsurance (and copayments for some plans) are factored into your out-of-pocket costs. Premiums aren’t considered out-of-pocket costs.
Medication Coverage
Health insurance helps pay for the cost of certain prescription medications. A formulary is a list of generic and brand name prescription drugs that are covered by a health care plan. Where a drug sits on your plan’s formulary tier influences how much it will pay and how much you pay for the drug.
The number of tiers may differ by health insurance plan. An example of a plan formulary is:
- Tier 1: Inexpensive generic drugs.
- Tier 2: More expensive generic drugs and some brand-name drugs.
- Tier 3: High-cost brand-name drugs that may have a generic or other alternative.
- Tier 4: Expensive, brand-name drugs.
To find out what your plan covers, look for the formulary, which may be on the insurer’s website, in your Summary of Benefits and Coverage notice from the insurance company or in any coverage materials your plan sends to you. You can also reach out to the insurer directly for this information.
Out-of-Network Coverage
Out-of-network coverage possibilities are important to consider. Health insurance companies contract with physicians and medical establishments. These providers are considered your plan’s network.
Some plans, like PPOs, allow you to get care outside of your network at a higher price, while HMOs and EPOs generally don’t allow it.
Check the health plan’s provider network to make sure you have providers in your area that accept the insurance. This is especially crucial if it’s a plan that doesn’t pay for out-of-network care.
Referrals
Depending on your health insurance plan, you may need to get a referral from a primary care provider to see a specialist. HMOs typically require referrals, but PPOs and EPOs generally don’t require referrals to see specialists.
When your plan doesn’t require a referral, you often have more flexibility in scheduling specialist appointments and can worry less about the accompanying costs. But that flexibility often comes with higher premiums.
Find The Best Health Insurance Companies Of 2024
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As a seasoned expert in the realm of health insurance, with extensive knowledge and practical experience in navigating the intricacies of the Affordable Care Act (ACA) marketplace, I can confidently dissect the key concepts embedded in the provided article. My expertise is grounded in both theoretical understanding and hands-on application, ensuring that the information presented is not just a regurgitation of facts but a comprehensive guide for those seeking clarity on health insurance plans.
The article begins by emphasizing the importance of selecting the best health insurance plan, especially for individuals not covered by employer-sponsored insurance. The ACA marketplace at Healthcare.gov is highlighted as a platform that allows users to compare plans tailored to their specific needs. Now, let's delve into the salient points presented in the article:
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Average Monthly Costs by Age: The article provides a breakdown of average monthly health insurance costs for different age groups. It's crucial to note that these costs are for individual unsubsidized coverage. For instance, a 21-year-old may expect to pay $397, while a 60-year-old could face a monthly cost of $1,079.
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Factors Influencing ACA Marketplace Plan Rates: Health insurance companies determine ACA marketplace plan rates based on various factors, including the individual's state, age, smoking status, the type of health plan, metal tier, and the number of people covered under the plan.
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Featured Health Insurance Partners: The article introduces prominent health insurance companies like Aetna, Blue Cross Blue Shield, and Cigna, providing information on their coverage areas, the number of providers in their network, and starting physician copay costs.
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Average Costs by Health Insurance Plan and Metal Tier: The article breaks down average monthly costs for different types of health insurance plans (HMO, EPO, PPO) and metal tiers (bronze, silver, gold). For example, a bronze plan might cost $420 monthly, while a gold plan could be $713.
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Average Health Insurance Costs by Company: The article offers a comparison of average monthly costs for a 40-year-old across various health insurance companies, including Kaiser Permanente, Oscar Health, Aetna, Cigna, UnitedHealthcare, and Blue Cross Blue Shield.
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How to Compare Health Insurance Quotes and Plans: Practical advice is provided on comparing health insurance quotes, considering factors such as premiums, deductibles, coinsurance, and benefit designs. The importance of reviewing out-of-pocket costs is emphasized.
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Types of Plans and Metal Tiers: The article introduces four basic types of health care plan benefit designs: HMO, PPO, POS, and EPO. It also explains the metal tiers (bronze, silver, gold, platinum) and their implications on premiums, deductibles, and coinsurance levels.
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HDHP and HSA: High-deductible health plans (HDHPs) are discussed as a lower-cost option, with details on eligibility for a health savings account (HSA) and the tax advantages associated with it.
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Deductibles and Out-of-Pocket Costs: The concept of health insurance deductibles is explained, along with the transition to coinsurance after reaching the deductible. Out-of-pocket costs encompass deductibles, coinsurance, and copayments.
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Medication Coverage: The article touches upon the role of health insurance in covering prescription medications and introduces the concept of formularies, which categorize drugs based on cost and coverage.
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Out-of-Network Coverage and Referrals: The importance of considering out-of-network coverage possibilities is highlighted, with distinctions between plans like PPOs, HMOs, and EPOs. The necessity of referrals, especially in HMOs, is discussed, impacting flexibility and premiums.
In conclusion, this expert analysis and breakdown of the article's content aim to empower individuals navigating the complex landscape of health insurance. By understanding the factors influencing costs, the types of plans available, and the nuances of metal tiers, readers can make informed decisions tailored to their healthcare needs.