How much does health insurance really cost?


Assistant Policy Analyst


Dedicated to affordable, quality healthcare and coverage for all Americans.

By Geraldine Slevin on Monday, November 24th, 2014

Now is the time to take a close look at your health insurance coverage options, whether you had health insurance this year or not. Even people who are happy with their current plans should see what’s available on Covered CA for 2015 – plan costs might have changed and you might find a better option starting in January.

For many people, cost is the most important factor in choosing between health plans. You may already know about the premium – the monthly amount you pay to your health plan to have coverage. This is probably the first number most people turn to when considering the cost of insurance. A plan’s premium will be different based on your age, where you live, and any premium tax credits you can get.

But the premium isn’t the only thing you should factor into your decision. Here’s a quick run-down of what you should think about when estimating out how much you might spend on healthcare in 2015:

  • The plan’s deductible, or the amount you have to pay out of your own pocket before your health plan will start paying anything. If you wouldn’t be able to pay a particular plan’s deductible over the year (or all at once, if you have an emergency and end up with a big hospital bill), you might want to look at plans with lower deductibles.
  • The plan’s co-insurance or co-payment amounts. These represent what you will  pay every time you visit a doctor or get your medications.. Pay close attention to co-insurance amounts – because they’re percentages, your costs can add up quickly when an expensive service or drug is involved.
  • The out-of-pocket maximum. This is a cap (or limit) on what you’ll have to pay during a year.  Once you spend the maximum, your insurance will pay the rest and you won’t have to pay co-payments or co-insurance any more.  .
  • Finally, your income matters. Depending on your family income, you may be eligible for premium tax credits, which lower how much your premium will cost you.  Your income might also make you eligible for lower cost-sharing if you choose a Silver plan, which means you would pay less every time you see a doctor or buy your medication.

(For more information on co-insurance vs. co-payments and other concepts, check out our simple fact sheets, here.)

Other elements of a plan, like the plan’s network of doctors and hospitals, are also important to the overall cost of the plan. To really understand what you might pay over the course of the year, you have to look at all aspects of a health plan. For example, if you think you’ll need a certain kind of medical care [example of something that may not be covered in nat’l exchange plans?], but that care isn’t covered by a plan, keep in mind that you may end up paying the full cost out-of-pocket. This can mean a pretty hefty bill. Or if you want to keep seeing your current doctor with your new plan, but he or she isn’t in the network, you may have to pay the out-of-network rate for your visits (or in certain plans, the full cost of the visit – yikes!).

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