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How Much Does Health Insurance Cost?

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While no one wants to overpay for health insurance, it's important to manage your risk and make sure you can afford the medical care that you or your family might need. No matter your situation, the overall amount you pay depends on your premiums, deductibles, copays, coinsurance, and out-of-pocket limits.

Premiums

The monthly premium you pay is influenced by a number of factors. These include:

  • Your age: Plans get steadily more expensive as you get older, until around 55 when rates significantly increase. People in their 60s and over could pay up to 3 times as much in monthly premiums as someone in their 20s with the same plan.
  • Your policy level: In most cases, health insurance policies are divided into 4 metal levels—Bronze, Silver, Gold, and Platinum. These determine how high your monthly premiums are, as well as what your deductible will be.
  • Where you live: State regulations, the cost of living, and how many insurers are available in your state can all affect what you pay.
  • Your medical history: Those who've needed a lot of medical care in the past should expect to pay higher premiums.
  • If you use tobacco: Tobacco users can be charged up to 50% more than individuals who don't smoke or chew.
  • The number of people on your plan: If you need to cover your spouse or children, the price of your plan can rise dramatically.

To get an even better idea of what you might pay based on your circumstances, the Kaiser Family Foundation offers a helpful tool based on 2019 government data. Using the form, enter your information to get an estimate on rates as well as whether you might qualify for financial assistance.

Deductibles

While premiums are a key cost point to consider, it's also important to think about your health insurance deductible and how that could affect your out-of-pocket costs. A deductible is the amount of money you have to pay of your own medical fees each year before your insurance begins payment. However, most plans cover certain preventive services, such as annual checkups, before you've reached this number.

In general, the lower your monthly premium, the higher your deductible will be. If you're young and healthy and have low risk for becoming sick or injured, a Bronze or Silver plan might work for you just fine. However, if you need medical services more frequently or take expensive prescription drugs, a Gold or Platinum policy might be the better choice. These plans cost more in monthly premiums but require you to pay less out of pocket when you need care.

Monthly PremiumDeductible
Lowest$7,900
Monthly PremiumDeductible
LowHigh
Monthly PremiumDeductible
ModerateModerate
Monthly PremiumDeductible
HighLow
Monthly PremiumDeductible
HighestVery Low

The only plan with a set deductible is Catastrophic coverage. As of 2019, these plans have the lowest premiums of all health insurance policies, but require you to pay $7,900 before your insurance kicks in. Unlike other pans, however, if you do reach your deductible, your insurance will pay for 100% of services that are covered by the plan.

Copayments & Coinsurance

But deductibles aren't the only fees you're required to pay for your medical care. With most plans, you're still responsible for what is known as copayments and coinsurance. A copay is a flat fee you pay to a healthcare provider before receiving services, such as $30 for a doctor's office visit. Your coinsurance is the percentage of medical bills you pay once you've reached your deductible.

These rates vary by the level of your coverage and specifics of your plan, but in general, policies with higher premiums and lower deductibles require a lower percentage of coinsurance. The exception is with Catastrophic plans, which are the least expensive per month and cover the largest percentage—but only after you pay $7,900 towards your medical bills.

After Paying Your Deductible, Your Plan Covers...Your Coinsurance Is...
100%0%
After Paying Your Deductible, Your Plan Covers...Your Coinsurance Is...
60%40%
After Paying Your Deductible, Your Plan Covers...Your Coinsurance Is...
70%30%
After Paying Your Deductible, Your Plan Covers...Your Coinsurance Is...
80%20%
After Paying Your Deductible, Your Plan Covers...Your Coinsurance Is...
90%10%

Out-of-Pocket Maximums

Out-of-pocket maximums are your safety net for large medical expenses, meaning that you can't pay any more than a specific amount within a single policy period. If you've paid the maximum, your insurance will take care of 100% of the costs for covered services within the remainder of the period. As of 2019, out-of-pocket maximums legally can't exceed $7,900 for individual plans and $15,800 for family plans. Depending on the policy you choose, your maximum could even be lower.

Keep in mind that the maximum only applies to what you pay in your deductible, copays, and coinsurance for covered services. Neither fees for services not covered by your plan or your monthly premium payments go toward your out-of-pocket max.

Extra Costs for Denied Medical Claims

When it comes to what you pay for your healthcare, it's important to understand what and who is covered by your insurance. If you submit a medical claim for a noncovered charge or see a physician that's not in your network, your claim could be denied, leaving you fully responsible for the cost. Those with Point of Service plans could also be denied if they sought treatment from a specialist without first getting a referral from their primary doctor. It's always a good idea to make a habit of asking if your insurance is accepted before receiving any sort of treatment.

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