How Much Does Individual Health Insurance Cost?
Understanding Health Insurance Costs for Individual and Family ACA Plans
If you purchase private health insurance for yourself or your family, Covered California provides cost-effective plan options. Finding the best plan for your budget means understanding how health insurance costs play a role in the coverage you receive. As you navigate your options, Covered California is a valuable resource for understanding benefits and coverage levels when comparing health insurance costs. Covered California was established by the Affordable Care Act (ACA) to help Californians access affordable healthcare coverage. So, how much is private health insurance through Covered California? Consider this article your guide to navigating insurance costs.
What is Individual and Family ACA Insurance?
Individual and family ACA insurance refers to the wide range of health plans offered through Covered California that you can purchase for yourself and your family. It is typically intended for those who do not have access to coverage through an employer-sponsored plan or do not qualify for government-run health insurance. By purchasing health coverage through Covered California, you have flexibility in choosing a health insurance plan that aligns with your care needs and budget.
Additionally, the ACA provides financial help in the form of health insurance subsidies to those who qualify, which can help lower or eliminate your monthly premium, as well as decrease your out-of-pocket costs for care. An estimated 9 out of 10 people nationwide qualify for financial help to lower the cost of their health plan.1
What Are the Costs of Individual Health Insurance?
Health insurance plan costs can vary depending on a number of factors. Your average health insurance costs are a combination of different coverage-related expenses that vary depending on your specific plan. These costs include:
- Premium: What you pay monthly to your insurer for your health plan.
- Deductible: What you pay for care before the plan pays.
- Copay: What you pay with every visit to a care provider. Copays are fixed amounts and can vary for different medical services.
- Coinsurance: The percentage of costs you pay after you meet your deductible.
- Maximum out-of-pocket limits: The most you will pay out-of-pocket annually for coverage. If you meet that limit, your insurer will pay 100% of all covered healthcare costs for the rest of the plan year.
How to Compare Individual Health Insurance Costs
Comparing ACA health insurance costs across different types of plans is essential to understanding what you can expect to pay for coverage. While ACA coverage can generally be more affordable for individuals and families shopping for a health plan through Covered California, coverage levels vary in how you and your insurer will share in the cost of care.
Understand How Your Monthly Premium Affects Other Costs
Your plan premium (the fixed amount you pay monthly for your coverage) directly impacts how much you will pay for other healthcare costs.
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Higher monthly premium |
Lower monthly premium |
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Pay less for: |
Pay more for: |
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Find a Plan That Fits Your Budget Through the ACA Marketplace
ACA plans available through Covered California are organized into four metal levels: Bronze, Silver, Gold, and Platinum. They are comprehensive plans that all cover the same essential health benefits, including doctors’ visits, hospital care, prescription drug coverage, and mental health services. The difference is in how you and your insurer share the overall cost.
| Plan |
Bronze |
Silver |
Gold |
Platinum |
|---|---|---|---|---|
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Your Plan Pays |
60% |
70% |
80% |
90% |
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Your Cost |
40% |
30% |
20% |
10% |
When comparing ACA health insurance costs, it is important to evaluate your unique care needs. If you do not see your doctor often beyond preventive care visits, you may be more comfortable choosing a plan with a lower premium—even if that means paying a higher annual deductible or paying more out-of-pocket for care. However, if you routinely see your doctor or specialists for an ongoing medical condition, choosing a plan with a higher monthly premium means that your copays per visit, prescription costs, and your annual deductible may be lower. Compare your anticipated care needs to the average health insurance cost per month for the plans you are considering to determine which metal level comfortably aligns with your budget and provides the coverage you will need.
How Can I Lower My Health Insurance Costs?
While health insurance is an important part of your annual cost of living, there are ways to save.
Discover If You Are Eligible for Health Insurance Subsidies
Purchasing health insurance through Covered California gives you access to financial help to lower your premium and other out-of-pocket costs, if you qualify. Health insurance subsidies are based on your household income and family size (including yourself, your spouse, if married, 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.
The ACA offers two primary types of subsidies: Advanced premium tax credits, which can be used to reduce or completely eliminate your monthly premium, and cost-sharing reductions, which are extra savings that can help lower your out-of-pocket costs for care if you enroll in a Silver plan. You may qualify for both advanced premium tax credits and cost-sharing reductions.
Save With an HMO
You can save by choosing a health maintenance organization (HMO) insurance plan. If you enroll in an HMO, you may need a referral from your primary care doctor to see a specialist, and out-of-network coverage is limited to emergencies. But overall, your health insurance costs will be less.
Choose a Plan With a Higher Deductible
If you’re healthy and don’t visit the doctor often except for preventive care, you can save on your monthly payments. Health insurance plans with a higher deductible will usually have a lower monthly premium.
Pick a Plan That Pairs With a Health Savings Account
Health savings accounts (HSAs) can help you pay for medical expenses. You save on taxes with a health savings account because the money you put in and then use to pay for your deductible, copays, and coinsurance is either tax-free or tax-deductible. Plans that pair with a health savings account have higher deductibles, so their premiums are typically lower.
Explore Your Plan’s Wellness Benefits
To help encourage members actively work towards maintaining or improving their overall health and well-being, Anthem offers Smart Rewards, an incentive program that allows you and your covered spouse or partner to earn rewards for completing certain health and wellness activities.2
Find an Affordable Health Insurance Plan
Anthem is here for you, no matter where you are on your personal health journey. When calculating your costs for health insurance, you may want help. We can suggest a plan that fits your coverage needs and your budget.
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References
1 Centers for Medicare & Medicaid Services: Health Insurance Marketplaces 2023 Open Enrollment Report (2023): https://www.cms.gov/files/document/health-insurance-exchanges-2023-open-enrollment-report-final.pdf
2 You and your covered spouse or partner can earn rewards for completing health and wellness activities. In some states, you need to complete these activities within 90 days of enrollment. After you complete an activity, you can open the Sydney Health app or go to Anthem.com to see how much you’ve earned. You can redeem your rewards for a digital gift card from a selection of retailers. We encourage members to actively participate in the rewards program. Rewards earned should be redeemed before the end of the current plan year. Unused rewards are forfeited three months after the end of your plan year, so members need to make sure to redeem them before then. Rewards eligibility applies only to subscribers and their enrolled spouse/domestic partner. Members must be active on the plan and their activity must take place during the plan year. The reward amount you receive may be considered income to you and subject to state and federal taxes in the tax year it is paid. You should consult a tax expert with any questions regarding tax obligations. Electronic gift card availability may vary. The list of retailers available for electronic gift card rewards redemption is subject to change. Log on to Anthem.com or open the Sydney Health app to explore the electronic gift card options available to you. A subscriber and enrolled spouse/domestic partner may earn rewards when eligible activities are completed and, in some instances, they may be verified by an Anthem claim.