The Cost Of Health Insurance Without A Subsidy

The rising cost of healthcare in the US has been a concern for a long time, leading to healthcare reforms like the Affordable Care Act (ACA) of 2010. This Act sought to make healthcare more affordable and accessible to all. One of the ways it did so was by making it easier to obtain affordable health insurance.

It undoubtedly made an impact. More Americans than ever are signing up for health insurance. Yet paying for health insurance is still a struggle for many American households due to the general cost of living and other economic factors. 

That is why so many people rely on subsidies to get the health insurance coverage they need. But is the cost of health insurance without a subsidy really out of reach for the average American? We look at the average costs and how your health insurance plan can still be affordable, even without subsidization. 

What Does Health Insurance Cost Per Month?

Your monthly insurance premiums determine your ongoing monthly costs. These premiums are fixed monthly payments that remain constant throughout the year for which you have signed up for coverage. You must pay this monthly premium, regardless of whether or not you claim any medical services.

Employer-Sponsored Plans

Small businesses with less than 50 full-time employees are not required to offer group health insurance. However, if a company offers health coverage to employees, they must pay for at least 50% of their employee’s premiums. The rest will come out of employees’ pre-tax income. 

Many Americans rely on employer-sponsored group health plans for affordable health insurance. These plans provide health benefits to employees listed on the group plan and often their dependents. 

Employer-sponsored insurance statistics show that they pay, on average, 78% of single-coverage employee health insurance plans and 66% of family coverage plans.

Individual Plans

Individual plans are available if you don’t have access to employer-sponsored insurance. You are responsible for paying the total monthly amount. However, the individual insurance plans on the ACA health insurance market are available at various price points. 

Without a subsidy, an individual health plan can cost about $300 to $800 on average per month. Subsidies are available, but these are based on your income and apply to the benchmark Silver plans in your state (we’ll take a closer look at this in a moment).

3 Factors That Influence Health Insurance Cost

You can find health insurance plans that fit just about any budget. But, your monthly premium is calculated on several factors such as your health status, lifestyle, and age. Even your location can affect what you pay. 

Here are the three top influential factors.

1. Benefit Design

The health insurance plan you choose will dramatically impact your costs. We don’t just mean your monthly payments. Everything from deductibles you must meet to cost-sharing like copayments and coinsurance affects what you pay throughout the year. 

What is known as the ‘benefit design’ is behind all the different types of health insurance available today.

Every health insurance plan has a benefit design. It determines the medical services covered and the provider network policyholders must use. Any cost-sharing amounts that policyholders are liable for will also be in the benefit design.

2. Plan’s Metal Tier

ACA marketplace health insurance plans are classified into four ‘metal tiers’. These are Bronze, Silver, Gold, and Platinum. 

Bronze and Silver plans are generally the more affordable plans. They have lower monthly premiums but may offer less coverage or have higher copays or coinsurance requirements. If you apply for an ACA health insurance subsidy, it is calculated on the benchmark silver plan in your state of residence.

Gold and Platinum-tier health insurance plans are usually the most expensive, with higher monthly premiums. However, these metal tiers also typically offer more comprehensive insurance coverage and lower cost-sharing expenses.

Examples:

  • You earn an average salary of $ 60,000 annually, are in your early 30s, are unmarried, and have no children. According to the KFF Health Insurance Marketplace Calculator, you would qualify for a small subsidy of $8. Your Silver plan will cost you $425 per month. 
  • You are married, but everything from the above example is the same. You and your spouse are both in your early 30s, have no kids, and have a combined income of $60,000 a year. You don’t have access to health insurance through an employer or spouse’s employer. Without a subsidy, a Silver plan for the two of you could cost about $894. Fortunately, you qualify for a subsidy of $589 per month. 

3. Health Insurance Company

The health insurance company backing your plan is very relevant to your costs. No matter which state you live in, you’ll find more than one insurer (and sometimes many) to choose from. Each of these insurance companies will also offer a variety of health insurance plan types. 

The pricing structure between insurers is often similar for comparable insurance plan types. But they are not necessarily the same. You may need to shop around to find the best deal.

Health Insurance Costs Per State

As a general guideline, the Bronze and Silver plans have the most affordable monthly premiums. But, the actual amounts you pay for your monthly premium can differ widely between states. 

For example, depending on your state and what is currently available there, the lowest average bronze plan premium ranges from $242 to $573. And the lowest average Silver premium can be $317 to $837. The reason for this disparity is availability. 

You can only access a health plan from an insurance company in your state. This availability is what ultimately dictates the price. If you need more information about health insurance affordability in your state, you can find it here

Generally speaking, you’ll pay 30-40% of your medical expenses out-of-pocket on a Bronze or Silver-tier health plan without a subsidy. They have lower monthly premiums, which often means higher copays or coinsurance requirements. That’s why your out-of-pocket costs are higher.

You’ll only have to pay about 10-20 % of the costs on Gold or Platinum health insurance plans. Although they usually have higher monthly premiums, they also feature lower cost-sharing requirements. Thus, your total contributions to medical services costs can be much lower.

How Can You Save On Health Insurance?

Health insurance has become a lot easier to sign up for and afford since the introduction of the ACA and its subsidies. But if you don’t qualify for a subsidy, there are still a few ways to reduce your health insurance costs. Here are the top three ways to save money while enjoying access to quality healthcare.

Select A High-Deductible Health Plan

A high-deductible health plan requires you to meet a high deductible amount before the insurance coverage comes into effect. While all health plans have deductibles, these plans have higher than usual deductible amounts. The upside is that the monthly premiums will be reasonably low. 

The high deductible may seem like a deterrent, but it is well-suited to people who need to save on monthly expenses. The high deductible is more of an issue if you seek medical care regularly because you are 100% responsible for your medical bills until you reach the plan’s deductible amount.

However, you can get around the financial implications of this plan with the very next tip on our list – a health savings account.

Set Up A Health Savings Account

A health savings account (HSA) is a tax-advantaged savings account designed to save towards medical expenses, such as deductibles. To qualify for an HSA, you must enroll in a high-deductible health plan. 

You can use the savings for various medical expenses, including deductibles, coinsurance, and copays, without incurring taxes. Plus, any unspent funds roll over at the end of the year, providing a long-term benefit for future health expenses. 

However, using HSA funds exclusively for medical purposes is crucial to retain tax advantages. If you withdraw money for non-medical reasons, you will be liable for income taxes and a 20% penalty. 

This HSA ‘penalty’ applies only to people under 65, as the penalty is waived for seniors over this age.

Choose An HMO Or EPO

You’ll find many health insurance plans on the ACA health insurance marketplace. Two of the most affordable types there are the HMO and EPO plans. 

Health Maintenance Organization, or HMO, plans consist of a network of doctors, hospitals, and other medical providers contracted to the insurer. These networks are generally small, and you’ll need a primary care physician to refer you for additional treatments when necessary. 

EPO plans also feature an exclusive provider organization (hence the acronym EPO), and they are some of the more affordable plans on the market. You’ll have access to a broader network of medical providers. And unlike the HMO, you won’t need referrals from a primary care physician.

An HMO plan is generally cheaper than an EPO plan, but both options are affordable. However, you should note that you will not be covered for services from medical providers outside these plans’ networks. 

What Are Health Insurance Subsidies? 

Despite the wide selection of affordable health plans on the ACA marketplace, some people still find health insurance too expensive. 

That is why subsidies like the Premium Tax Credit and Cost Sharing Reduction (CSR) have been made available to those who need them. You can apply for them when you apply for health insurance on the ACA marketplace.

Which Costs Do Cost-Sharing Subsidies Help With? 

Cost-sharing subsidies help with upfront, out-of-pocket expenses. These include copayments, coinsurance, and deductibles. These subsidies do not lower monthly premium costs. If you find your monthly health insurance costs too much of a burden, the premium tax credit is a better subsidy for you.

How Do People Receive The Premium Tax Credit?

The premium tax credit is a form of ACA health insurance subsidy available to people struggling to afford health insurance. The IRS oversees this health insurance subsidy. To be eligible for it, you must be a registered income taxpayer. You will also have to meet eligibility criteria, mostly income-based. 

There are two ways to receive the ACA premium tax credit (PTC).

  1. You can have the credit amount paid directly to your insurance provider to help you afford your monthly premiums.
  1. Claim the PTC on your income tax return.

To check your eligibility for the premium tax credit, read our guide to ACA Premium Subsidy Eligibility. 

How To Choose The Best Health Insurance

Before we discuss how to choose the best health insurance, consider this question – what is ‘the best’ health insurance? The best health insurance plan is always the one that is best for you. Choosing the best health plan for yourself and your family is impossible without considering your unique situation. 

Everyone has different needs when it comes to health insurance. However, you can make your decision more easily when you consider the following factors:

  • How many people in your household need coverage, and what are their ages? A family with young children or older people may have higher medical needs than those in their 20s to 40s.
  • Do you or any of your dependents have higher medical care needs? Any age group can have high medical care needs if a chronic illness or disability is involved. Do you need a health plan that offers good value for such a consistent need for medical services?
  • Are you likely to use the health plan’s benefits only when an emergency arises? If you are under 30, in good health, and rarely need to see a doctor, this plan may be the solution. It has a high deductible and limited medical benefits but is much more affordable than other health plans.
  • Would lower monthly premiums be better for you, even if you had to reach a higher deductible before enjoying insurance coverage? Consider signing up for a high-deductible plan with a health savings account to help.

Conclusion

The best way to deal with rising healthcare costs and handle the costs of unexpected medical emergencies is to have adequate health insurance. And ACA subsidies are available for people who don’t have employer-subsidized insurance and can’t afford individual insurance plans. 

These subsidies are income-based, and you may not be eligible. But budget-friendly health insurance is still an option for you, regardless of your employment status or income. You just need some help from industry experts like the consultants at Enhance Health.

Give us a call today. We’ll help you find a health insurance plan that fits your needs and budget.

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