In 2020, the average national cost for health insurance is $456 for an individual and $1,152 for a family per month. However, costs vary among the wide selection of health plans. Understanding the relationship between health coverage and cost can help you choose the right health insurance for you.
What is individual health insurance?
While many people get their health insurance through a group plan sponsored by their employer or union, others buy it themselves. If you are buying your own health insurance, you are purchasing an individual plan, even if you include family members on the plan. If this sounds like what you need, let eHealth show you all of your individual and family health insurance options, and use our free quote comparison tool to find an affordable plan that meets your needs.
As a result of the Affordable Care Act (ACA), people can purchase individual health insurance through a government exchange or marketplace (commonly referred to as ACA plans), or they can buy health insurance from private insurers. You may be restricted to purchasing health insurance through a government exchange to certain times of the year. Usually you can purchase health coverage from a private insurance company anytime.
ACA plans are a good starting place to understanding individual health insurance options. ACA health plans are categorized by metals. You can learn more about the metallic plans: Bronze, Silver, Gold, and Platinum.
All ACA plans must cover 10 essential benefits, such as coverage for hospitalizations, outpatient and preventive care, maternity and child services, lab tests, rehabilitation services, mental health treatment, and prescription drugs. Each insurer can decide how it provide these benefits, and perhaps additional benefits. The metallic levels help buyers understand what portion of health care costs the plan will pay on average and what portion the consumer will pay.
How much does individual health insurance cost?
The cost of individual health insurance varies. Personal choices in coverage as well as age, income, location, number of family members (if any) included in your coverage, health care use – factor into your actual health insurance cost.
You can get a reliable estimate of your costs when you know health plan’s premiums, deductibles, cost-sharing expenses and maximum out-of-pocket limits. With this information, you can also compare health insurance plans. Licensed insurance brokers at eHealth offer expert knowledge in available health plans. They can help you compare options to find the affordable health plan that meets your needs.
In exchange for healthcare coverage, the insurer charges you a monthly premium.
According to eHealth’s recent study of ACA plans, in 2020 the national average health insurance premium for an ACA plan is $456 for an individual and $1,152 for a family. This average cost does not include people who receive government subsides.
Deductibles and cost-sharing expenses
A deductible is the amount you pay for health care services each year before your health insurance pays its portion of the cost of covered services. Our study finds that in 2020, the average annual deductible for single, individual coverage is $4,364 and $8,439 for family coverage. Keep in mind, individual health insurance plans’ deductibles vary considerably: some may be as low as $0.
Copayments and coinsurance are cost-sharing payments you make each time you get a medical service after reaching your annual deductible.
A copayment is a fixed amount that you pay for covered health care services. For example, assume your plan has a $30 copayment and your doctor’s visit is $150. If you:
Haven’t met your deductible, you’ll pay $150 at the time of your visit
Have met your deductible, you’ll pay your $30 copayment
Coinsurance is a percentage of covered health care service that you pay for covered services after you have met your deductible. Assume your plan has a 20% coinsurance and your doctor’s visit is $150. If you:
Haven’t met your deductible, you’ll pay $150 for the visit
Have met your deductible, you’ll pay 20% of $150 (which is $30)
Maximum out-of-pocket limits
The maximum out-of-pocket limit is a financial safety net. This dollar amount is the most you have to spend for covered services in a year. After you reach this amount, the insurance company pays 100% for covered services for the rest of the benefit year. Your deductible, copayments and coinsurance payments count toward the annual maximum out-of-pocket limit.
For the 2020 plan year, the out-of-pocket limit for an ACA plan can’t be more than $8,150 for an individual and $16,300, as reported on Healthcare.gov. Many plans offer lower out-of-pocket limits.
How do premiums, deductibles, cost-share, and out-of-pocket limits influence health care cost?
Generally, the more benefits your plan pays, the more you pay in premium. But your medical expenses for care are lower.
To illustrate how these costs may influence your choice of plans, consider the ACA plans.
The Bronze plan has the lowest premiums of the ACA metallic categories of plans. The national average premium in 2020 for single coverage is $448 per month, for family coverage, $1,041 per month, according to our study. A Bronze plan may be right for you if your primary goal is to protect yourself financially from the high cost of a serious illness or injury and still pay a modest premium. However you will have to pay for much of your routine medical care. The plan pays for preventive care (such as an annual wellness visit, certain screenings and counseling) whether or not the deductible is met.
A Silver plan may be a good choice for you if you can afford a slightly higher premium than a Bronze plan premium to get more insurance payment for medical care. The national average Silver plan premium in 2020 for single coverage is $483 per month. Family coverage averages $1,212 per month.
A Gold plan may be the right choice for you if you are willing to pay even more each month in premiums to have more of your medical care expenses paid by insurance than a Bronze or Silver plan would pay. A Gold plan may be especially valuable to you if you or your family require frequent or extensive medical care. The national average Gold plan premium in 2020 for single coverage is $569. For family coverage, the average premium is $1,437 per month.
If you can afford to pay more in monthly premium costs in exchange for small medical expenses related to extensive, ongoing health care, the Platinum plan may be a good choice. In 2020, the Platinum plan premium averages $732 per month for single coverage and $1,610 per month for family coverage.
In addition to the metallic plan categories, some people are eligible to purchase a plan with catastrophic coverage. Catastrophic plans have very low premiums and very high annual deductibles ($8,150 in 2020). However, they pay for preventive care regardless of the deductible. These plans may be a suitable insurance option for young, healthy people. To qualify for a Catastrophic plan, you must be under age 30 or be of any age with a hardship exemption or affordability exemption (based on job-based or exchange insurance being unaffordable).
How to find an affordable plan that meets your needs?
Among eHealth customers who bought ACA individual health insurance, more than 75% chose Bronze or Silver plans. Your state may host an exchange for comparing and purchasing ACA plans or it may use the federal exchange at Healthcare.gov. Keep in mind, you aren’t limited to the exchange.
The licensed insurance brokers at eHealth can help you find the best health plan to meet your health coverage needs and your budget. They will listen to your priorities in health coverage and use their expertise to match your needs with health insurance options both on and off the exchange.
Can I lower my health insurance costs?
You can’t control when you get sick or injured, but you do have some control on how much you pay. While an eHealth broker can help you identify potential cost controls for your particular situation, here are some ways you may be able to lower your health insurance costs.
See if you’re eligible for government subsidies. If you buy your own health insurance, you may get help paying for it from a government assistance program. The Advanced Premium Tax Credit subsidy lowers your monthly premium payment. The Cost-Sharing Reductions program can lower the cost-share amount you pay for medical care. Both of these programs are designed to help people with limited incomes.
See if you’re eligible for Medicaid. Every state has a Medicaid program and Children’s Health Insurance Plan (CHIP) to provide health coverage to low income individuals and families. Contact your state Department of Insurance or Health Department to learn more about these programs and if you are eligible to enroll.
See if you are eligible for Medicare. You may be eligible for Medicare if you are age 65 or older—even if you are still working—or any age and disabled. The standard monthly premium for Medicare Part B (medical insurance) is $144.60 for 2020. Most people who have worked at least 10 years and paid Medicare taxes do not pay a Part A (hospital insurance) premium.
Choose a high deductible plan that pairs a health savings account (HSA). If you aren’t eligible for government assistance programs, you may save money with this insurance plan type. The premium is low for high-deductible plans and many plans pay for some preventive care. The HSAs are savings accounts that you use to pay for medical expenses not paid by your insurance. You save on taxes with a health savings account because the money you put in and take out is either tax-free or tax-deductible.
Buy a medical supplement plan and a high-deductible plan. You may be able to save money by choosing a high-deductible plan that will help pay your expenses if you are seriously ill or injured and a supplemental insurance plan. Supplemental insurance provides coverage for specific health conditions, such as accidents, types of critical care, disability, or death. Typically, the premiums for these types of plans average $25 – $50 per month and usually don’t have deductibles.
Are you ready to find the right individual health insurance for you?
eHealth is here to help you. We have licensed insurance brokers who understand the various coverage options and can guide you through your individual insurance health insurance choices. Our service is quick and convenient and free of charge. Call us at (910)227-9220, Mon–Fri, 10am–6pm ET, or email us at info@SIA.fund.
This article is for general information and may not be updated after publication. Consult your own tax, accounting or legal advisor instead of relying on this article as tax, accounting, or legal advice.