Understanding The Cost Of Family Health Insurance

Comparing Family Health Insurance Costs

There are several costs to consider when comparing family health insurance plans. It’s important to keep these costs in mind when you think about the coverage that you and your family will need.

Premium – what you pay monthly for your plan

Deductible – what you will pay before your plan begins paying for care

Copay – what you may pay with every visit to a provider

Coinsurance – the percentage of costs you pay for care after you meet your deductible

Out-of-pocket maximum – the most you will pay for care in a plan year

Family Health Insurance Plan Types

Family medical insurance plans can vary in coverage, cost, and access to doctors and specialists. By understanding the different types of health insurance, you can select a plan that best balances your family’s coverage needs with your budget. 

HMO (Health Maintenance Organization)

An HMO offers coverage from select in-network doctors and hospitals. Most Anthem HMO plans are open access, which means they do not require a referral to see a specialist. An HMO will not cover out-of-network providers unless it is an emergency or urgent care visit in most states. The HMO in-network model helps keep healthcare costs lower for members. 

PPO (Preferred Provider Organization)

A PPO is a health plan with a “preferred” network of providers in your area and does not require a primary care provider (PCP) referral to see a specialist. A PPO health plan generally has higher premiums than an HMO plan and may have  higher out-of-pocket costs. A PPO also provides coverage for services out of network.

EPO (Exclusive Provider Organization)

An EPO is a hybrid of an HMO and a PPO. EPOs generally offer a little more flexibility than an HMO and are usually less expensive than a PPO. EPOs allow members to see specialists without a referral from their primary care doctor. Coverage for out-of-network costs is limited to emergencies or urgent care visits  in most states.

Family Health Insurance Plans Through The Marketplace

Health Insurance Marketplace plans provide affordable coverage for families through the Affordable Care Act (ACA). They are comprehensive plans that cover the 10 essential health benefits, including doctor visits, prescription drug coverage, hospital care, and mental health services.

There are four types of Marketplace health insurance plans: Bronze, Silver, Gold, and Platinum. The plans differ in how you and your insurance provider share the overall cost.

Bronze Plan

• What your family plan pays: 60%
• Your cost: 40%

Silver Plan (Cost Share Reduction) 

• What your family plan pays: 70%
• Your cost: 30%
• Cost-sharing reductions may also apply

Gold Plan

• What your family plan pays: 80%
• Your cost: 20%

Platinum Plan

• What your family plan pays: 90%
• Your cost: 10% 

Ways To Save On Family Health Insurance Costs

Check ACA tax credit subsidies

Purchasing a family health insurance plan through the Marketplace may offer you access to financial help to lower your premium if you qualify. Health insurance subsidies are based on your earnings and family size (including yourself, your spouse, and anyone you will claim as a tax dependent — even if they do not need coverage). Subsidies also consider the cost of health coverage in your state. If you qualify, you may be able to lower or eliminate your monthly premium.

Select a plan with lower premiums

You can save by choosing a plan that has lower monthly premiums, such as an HMO insurance plan. You may need referrals from your primary care doctor to see specialists, and out-of-network coverage is limited to emergencies. But overall, your monthly health insurance costs will be lower.

See if your children qualify for CHIP

The Children’s Health Insurance Program (CHIP) is a state resource that provides low-cost or free health insurance for families with children if they meet the enrollment qualifications.

We Can Help You Navigate Your Health Insurance Options

Count on our experience and support to enroll in health coverage. We can help you choose a health insurance plan with Anthem and guide you through the process.