The Affordable Care Act (ACA), more popularly known as Obamacare, was signed into law in 2010 to give everyday US citizens wider access to healthcare and health insurance.
The Obamacare health plans offered on the federal health insurance marketplace have varying price points. But without the additional subsidies offered for lower-income households, many would still find health insurance unaffordable.
The type of health plan coverage and your individual income and other criteria can affect what you pay.
So how much does Obamacare cost per month for the average person? And is there a way to bring these costs down? Continue reading to find out.
Obamacare Plans
There are four health insurance plan tiers available through ObamaCare’s Marketplace. These are Bronze, Silver, Gold, and Platinum.
These four tiers represent four levels of coverage. The lower levels have lower monthly premiums and less coverage than the higher ones do.
You enjoy more comprehensive health insurance coverage the higher up the rungs you go (with Bronze offering the least and Platinum the most).
Your copayments and other deductibles may be vastly different, too.
For example, a Bronze or Silver plan will have lower monthly premiums. But when you need medical treatment, your out-of-pocket expenses before your coverage applies are higher. The reverse applies to Gold and Platinum plans – higher premiums, but lower out-of-pocket expenses when you need treatment.
Here’s a table outlining how the costs are split between you and your chosen insurance plan:
| Obamacare Plan | How Much Insurance Pays | What You Pay |
| Bronze | 60% | 40% |
| Silver | 70% | 30% |
| Gold | 80% | 20% |
| Platinum | 90% | 10% |
The prices you’ll pay can differ from state to state, too. Also, each state will have its own preferred insurance companies on its networks.
How To Choose The Right Obamacare Health Insurance Plan
Choosing the right Obamacare health insurance plan is largely dependent on your individual circumstances.
What is your age and the state of your health? Are you married with dependents? And, most importantly, how much can you afford to pay? These are all questions you should ask yourself before deciding on a health plan.
A young, healthy single individual will have far different healthcare needs than a middle-aged parent of school-aged children. And although usually spared the responsibilities of supporting a growing family, seniors often have health-related issues that may incur costly treatments.
The more responsibilities you have, or the more delicate the state of your health is, the more comprehensive a health plan you’ll need. This will be more expensive than a basic plan for one person.
The Average Cost Of Obamacare Per Month
Despite these individual factors and the wide selection of plans on the health insurance marketplace, it’s possible to come to an average amount for Obamacare monthly health plan premiums.
Your income level, age, and number of dependents make a big difference to what you’ll end up paying.
But for the purposes of illustration, let’s look at the average premiums of 40-year-olds.
The table below shows the lowest-cost premium for each tier and the second-lowest-cost silver (benchmark) premium for a 40-year-old individual in each state. Take note that these costs don’t account for premium tax credits, which can reduce your monthly premium amounts.
State | Average Lowest Bronze Premium | AverageLowest Silver Premium | Average Lowest Gold Premium | Average Benchmark Premium |
| Alabama | $408 | $553 | $687 | $567 |
| Alaska | $458 | $746 | $674 | $762 |
| Arizona | $326 | $405 | $478 | $410 |
| Arkansas | $354 | $411 | $491 | $416 |
| California | $342 | $411 | $453 | $432 |
| Colorado | $292 | $376 | $363 | $380 |
| Connecticut | $515 | $592 | $577 | $627 |
| Delaware | $403 | $542 | $528 | $549 |
| District of Columbia | $396 | $426 | $495 | $428 |
| Florida | $353 | $468 | $459 | $471 |
| Georgia | $328 | $411 | $433 | $413 |
| Hawaii | $329 | $430 | $439 | $469 |
| Idaho | $325 | $415 | $444 | $420 |
| Illinois | $340 | $449 | $482 | $453 |
| Indiana | $327 | $395 | $521 | $397 |
| Iowa | $346 | $475 | $451 | $484 |
| Kansas | $353 | $467 | $480 | $471 |
| Kentucky | $333 | $417 | $472 | $422 |
| Lousiana | $423 | $550 | $624 | $565 |
| Maine | $372 | $449 | $507 | $457 |
| Maryland | $242 | $334 | $323 | $336 |
| Massachusetts | $347 | $407 | $522 | $417 |
| Michigan | $266 | $354 | $398 | $362 |
| Minnesota | $287 | $328 | $376 | $335 |
| Mississippi | $401 | $462 | $548 | $461 |
| Missouri | $385 | $472 | $562 | $473 |
| Montana | $343 | $471 | $521 | $477 |
| Nebraska | $414 | $549 | $579 | $550 |
| Nevada | $295 | $385 | $464 | $386 |
| New Hampshire | $266 | $317 | $359 | $323 |
| New Jersey | $358 | $435 | $674 | $441 |
| New Mexico | $357 | $429 | $353 | $445 |
| New York | $484 | $619 | $799 | $627 |
| North Carolina | $352 | $501 | $531 | $512 |
| North Dakota | $296 | $463 | $452 | $475 |
| Ohio | $322 | $411 | $455 | $413 |
| Oklahoma | $372 | $503 | $507 | $510 |
| Oregon | $343 | $453 | $493 | $462 |
| Pennsylvania | $292 | $420 | $380 | $433 |
| Rhode Island | $270 | $364 | $379 | $379 |
| South Carolina | $355 | $489 | $515 | $496 |
| South Dakota | $459 | $608 | $626 | $626 |
| Tennessee | $341 | $471 | $477 | $473 |
| Texas | $324 | $464 | $407 | $461 |
| Utah | $331 | $462 | $545 | $471 |
| Vermont | $641 | $837 | $894 | $841 |
| Virginia | $277 | $354 | $360 | $371 |
| Washington | $280 | $382 | $395 | $395 |
| West Virginia | $627 | $822 | $839 | $824 |
| Wisconsin | $334 | $449 | $462 | $456 |
| Wyoming | $573 | $801 | $708 | $802 |
(Information in table sourced from kff.org)
Benefit Designs And Their Effect On Your Premium Costs
In health insurance, the ‘benefits’ are the healthcare services, medical procedures, and medications covered by the insurer. So, the benefit design of a health insurance plan refers to the structure and rules of that particular health plan.
The benefit design, therefore, dictates preferred healthcare provider networks, the options for out-of-network care, if specialists’ referrals are included or not, etc. It can also affect the premium you pay.
Lower Premiums, But More Restrictive
Health Maintenance Organization (HMO), and exclusive provider organization (EPO) plans are the most common health insurance plan types under Obamacare. But although they are more affordable, their benefit designs are quite restrictive.
Higher Premiums, But With Fewer Restrictions
The other health plan types are known as preferred provider organization (PPO) and point of service (POS) plans. These allow out-of-network care and are less restrictive in their design, but you’ll pay a higher premium for the privilege.
What If I’m Unemployed?
Have you recently been dismissed or retrenched? You may be eligible for continued coverage under your former employer’s sponsored health insurance. This is subject to the rules of the Consolidated Omnibus Budget Reconciliation Act (COBRA). Take note that not all health plans meet the criteria
However, even if your health plan and your circumstances qualify you for COBRA, it may not be best for you. Without the continued contributions from your employer, you may find continuing with their health plan unaffordable at this time. Also, this Act only guarantees continued coverage for a limited time.
If you’re unemployed and have exhausted your COBRA options, you don’t have to worry.
You’re even more eligible for most Obamacare plans, provided you have no other sources of income that raise you too far above the Federal Poverty Line. There are some other criteria though, and we’ll be taking a look at those, next.
Who Qualifies For Obamacare?
You are eligible for affordable health insurance under Obamacare if you:
- Are a US citizen, a legal resident, or are deemed to be legally living within the borders of the United States due to other reasons. (If you have refugee status, see our immigration status list, below).
- Are not incarcerated at the time of enrollment for Obamacare.
- Have no health insurance coverage under a spouse, parent, or employer-sponsored plan.
- Have a net annual income of no more than 400% of the annual Federal Poverty Level (FPL).
The FPL is reassessed yearly and in 2023 is set to $14,580.
If you have one of the following immigration statuses, you qualify for marketplace coverage under Obamacare:
- Lawful Permanent Resident (Green Card holder) or Lawful Temporary Resident
- Political asylee or refugee
- Cuban/Haitian Entrant
- Paroled into the U.S.
- Conditional Entrant (granted before 1980)
- Victim of Trafficking and his/her spouse and dependents
- Granted Withholding of Deportation or Withholding of Removal, under either the immigration laws or the Convention against Torture (CAT)
- Non-immigrant Status, but with a legal work visa (like H1, H-2A, H-2B), study visa, or similar
- Citizens of Micronesia, the Marshall Islands, and Palau working in the US.
- Temporary Protected Status (TPS)
- Deferred Enforced Departure (DED)
- Deferred Action Status
- Member of a federally-recognized First Nation tribe
- American Samoa resident
You will not pay higher premiums than any qualifying US citizen. Your eligibility will still be based on your income.
How To Apply For Obamacare
How do you apply for Obamacare? There are several ways to do this, but it has to be done within the Obamacare Enrollment Period. This runs from November 1st to January 15th each year.
If you missed this enrollment period, you can take out short-term insurance to bridge the gap until the next enrollment period. Certain individuals are eligible for special enrollment if major life events prevented them from signing up in the specified period.
Check the details at healthcare.gov to know if this applies to you.
You can sign up for Obamacare on the Federal Health Insurance Marketplace, or if applicable, your own state’s marketplace. But the jargon can be very confusing for the layperson. So for easier Obamacare sign up, and help with selecting the right plan for you, contact Enhance Health.
What To Know About Obamacare Tax Credits & Other Subsidies
Even with the wide array of affordable health plans on the marketplace, some people struggle with the cost of Obamacare. That’s why additional subsidies like the Premium Tax Credit and Cost Sharing Reduction (CSR) have been made available to those who need them.
But how do they affect your Obamacare insurance cost?
The Premium Tax Credit lowers the monthly premium cost of qualifying applicants. This is tied to your income level, although you still need to meet the other requirements for Obamacare.
There are two ways in which you can benefit from Premium Tax Credits. The tax credit can be applied throughout the year and paid directly to your health insurer to reduce your premium. Or you can pay your monthly premium in full and receive a lump sum tax credit when you file your income taxes.
Cost Sharing Reductions, however, don’t make a difference to your monthly premium expense. What this type of subsidy does, is lower your upfront, out-of-pocket expenses like copayments, coinsurance, and deductibles, which most Obamacare plans also have.
Who Qualifies For Premium Tax Credits And Cost Sharing Reductions Or Other Subsidies?
You’ll qualify for such Obamacare subsidies if your annual net income for your entire household is lower than 400% of the Federal Poverty Line. If it is less than 150% of the FPL, you could get access to a Silver Plan on the Obamacare marketplace, with a zero-rated monthly premium.
Your income is the main factor in calculating your eligibility. But there are two other important things to note here. If you don’t file taxes for whatever reason, or have a spouse and file separate taxes from them, you may not be eligible for a Premium Tax Credit.
When you apply for Obamacare, you can apply for these subsidies, too. But the final decision about whether or not you qualify for them rests with the government. Don’t be tempted to give inaccurate financial information, as this is a criminal offense.
Frequently Asked Questions About Obamacare
Is Obamacare health insurance the same as private health insurance?
Yes. The health insurance plans available on your state health exchange or the Federal Health Insurance Marketplace are the same type of private health insurance plans offered everywhere else. However, under Obamacare, you’ll have greater access to these plans as a low-income earner.
Is it legal to forego Obamacare, even if I have no other insurance?
Technically, no. Under Obamacare, all US citizens have greater access to affordable health insurance and are thus legally required to have insurance. You don’t have to be covered by Obamacare, but you must have legally recognized health insurance. In some states, a lack of insurance carries a tax penalty.
Is Medicaid part of Obamacare?
No, these are two different things entirely, although it’s easy to see why they get confused with each other. Both offer health coverage but while Medicaid is run by the government, Obamacare expands on this by making private healthcare more accessible to all.
Conclusion
Under Obamacare, even lower-income earners or the unemployed can have affordable health insurance and good healthcare. Healthcare is a necessity, even if you are currently in good health. You’re risking your quality of life by going without insurance.
Don’t let the cost of Obamacare plans per month worry you. We can help. Our team of experts is on hand to help you choose a plan that meets your budget, whatever it is. So give us a call today, and make the right choice for you and your family’s health.
