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| Plan | Description | Insurer’s Responsibility for Cost of Care | Your Responsibility |
|---|---|---|---|
| Bronze | Lowest premium, highest deductible and out-of-pocket costs | 60% | 40% |
| Silver | Moderate costs and premiums | 70% | 30% |
| Gold | High monthly premium, lower out-of-pocket costs | 80% | 20% |
| Platinum | Highest premium, lowest out-of-pocket costs | 90% | 10% |
| Catastrophic | Only available to those under 30 or who qualify for hardship exemptions; very low premiums and very high deductibles | Insurer pays 100% of in-network provider costs after you meet the deductible | $9,450 deductible |
Tobacco Use
Your healthcare costs could be impacted if you used any tobacco product or products four or more times per week within the past six months. Your rates could be as much as 50% higher compared to someone who doesn’t smoke. So, if a nonsmoker pays $500 monthly, you could pay $750.
Location
Each state is divided into rating areas, typically by county or groups of counties. Issuers use those rating areas to set premiums—all premiums in a particular rating area are similar, with adjustments only based on age and smoking status. So, your insurance premium could increase or decrease depending on whether you move out of one county into another or from one state to another.
Family Size
In general, the tiers of family size are as follows:
- Single: Insurance for one person
- Couple: Two people who are married
- Single parent: Head of household (HoH) with one or more children aged 25 or younger
- Family: Couple with one or more children aged 25 or younger
For ACA plans, the single parent and family premiums are tiered based on whether you have one, two, or three or more children under age 21. If you have four or more children, you’ll pay the same rate as someone with three children. For individual Marketplace plans , your income and family size also affect your monthly subsidy.
Total Costs for Health Insurance
When you add up your total health care expenses, consider your insurance premium plus any other ongoing costs. Your total health insurance costs could add up to almost $20,000 per year for a family. Beyond the monthly premium, you’ll also pay for the following:
- Deductibles: You must spend this amount before coverage begins for your in-network medical care and medications.
- Copayments and coinsurance: These refer to the percentage or flat-rate dollar amount you pay for services such as PCP and specialist visits; emergency room treatment; and generic, preferred, and specialty medications.
- Maximum out-of-pocket expenses: This is the total you spend in a year (including the two amounts above) before your insurance begins covering all expenses.
Add up the totals you think you’ll spend plus premiums to estimate the total cost of your health insurance. In general, ACA plans will usually cost more than a group plan.
In 2024, your out-of-pocket costs (deductible, copayments, and coinsurance) can’t be more than $9,450 for one person and $18,900 for a family for an ACA plan. The out-of-pocket costs don’t include your premiums or non-covered medical services.
How to Buy Health Insurance
Buying health insurance depends on your life situation and available options. The options include:
- Enrolling in an employer plan through your workplace or your spouse’s
- Buying private health insurance through an agent or on the federal Marketplace or your state’s marketplace
- Qualifying for Medicaid based on your income and family status
- Applying for COBRA coverage if you’ve recently left a job and you qualify
- Enrolling in Original Medicare or a Medicare Advantage plan, if eligible
Depending on your state and circumstances, you might enroll during open enrollment or qualify for a special enrollment period.
Alternatives to Health Insurance
Alternatives to health insurance can include primary care memberships (paying a subscription fee to access services), healthcare sharing ministries, medical discount cards, and short-term health insurance. However, many of these alternatives are not regulated like other types of insurance and so lack essential consumer protections.
Of course, going without health insurance is another alternative—but it could lead to serious consequences, such as crushing medical debt or state-based tax penalties.
Frequently Asked Questions (FAQs)
How Much Is Health Insurance for a Family of Four?
Much depends on how you get your health insurance. If you have an employer-based plan, the cost of a family plan, on average, is $6,575 annually, or around $548 a month. Compare this to $1,622.90 for an ACA plan for a family of two adults and two children. However, depending on their income, families may also qualify for financial help through the Marketplace. Or your children could qualify for Medicaid or the Children’s Health Insurance Program (CHIP).
How Much Is Health Insurance Without a Job?
You could qualify for free or low-cost Medicaid health insurance or $0 premiums for a Marketplace health insurance plan based on your household income, state of residence, family status, disability, or other factors. Nearly 25% of California health marketplace enrollees have $0 premiums. Health insurance pricing is not based on your employment status. The best health insurance for unemployed people will have low premiums, copays, and deductibles, and offer catastrophic plans that could tide you over if you’re in a temporary bind.
Are Health Insurance Premiums Tax Deductible?
In general, any premiums you pay for health insurance (including Medicare) are deductible as medical expenses. However, the rules can get complicated. Participants in an employer-sponsored plan can only deduct premiums that appear on their W-2 form. Self-employed persons may be able to deduct premiums as an adjustment to income. For specific guidance, consult your tax adviser or the Internal Revenue Service.
What Is The Most Common Type of Health Insurance Plan?
Preferred provider organization plans (PPO) were the most commonly-used plan among employees, KFF found, with 47% of covered workers enrolled in a PPO. High-deductible health plans with a savings option ranked second at 29%, followed by HMOs (13%) and POS plans (10%).
What Is the Most Expensive Health Insurance?
On the ACA Marketplace, a platinum plan will feature the highest monthly premiums. However, you’ll pay less for doctor’s visits and medications and have a lower deductible. The insurance company will pay 90% for each covered medical service, while you’ll pay 10%.
The Bottom Line
Everyone needs medical insurance but the costs can vary widely, depending on such factors as your age, family size, where you live, and how you buy your coverage. Obtaining health insurance through your employer is typically the least expensive option, unless you qualify for low-cost or no-premium insurance programs offered by the government or on the ACA Marketplace. You can also purchase coverage directly from a private health insurance company.
