Types of Health Insurance Costs & How to Compare Them?- Call us at iHealthBrokers today at 888-410-0344. Our services are 100% Free!
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0:00 Intro
0:34 Monthly Premium
0:52 Group Insurance
2:30 Marketplace Premiums
4:40 Private Insurance
5:28 Deductible
6:33 HDHP & HSA
9:03 Copays & Coinsurance
9:37 Metal Tiers
10:25 HMO vs PPO
10:59 OOP MAX
12:31 Final Thoughts
Under the ACA, if your company has more than 50 FTE, they must provide health insurance and pay at least 50% of the premium. Your dependents will also be covered until they are at least 26.
Group health insurance plans often have much lower premiums when compared to other types of health insurance because of the bulk discount employers received by purchasing so many plans.
Marketplace plans may come with a bit of sticker shock if you’ve had group health insurance in the past. However you may be able to save thousands of dollars per year if you are eligible for a premium tax credit.
Premium tax credits are tax credits which are paid upfront. These are reflected in highly discounted monthly premiums. Your eligibility is determined by your income and household size.
Under the inflation reduction act, the subsidy cliff has been smoothed out and more people are eligible for premium tax credits even in higher income brackets. It is now more on a sliding scale.
Unlike ACA plans and group plans, private insurance plans can charge more based on health and pre-existing conditions. These types of plans can be much more expensive than group health insurance or marketplace plans. However, there are many, many options to choose from.
One type of private insurance is short term medical insurance. Although these plans are not ideal for everyone and they are not available in all states, they can offer significant cost savings on monthly premiums. A monthly premium for a young, healthy person for a STM plan could be as low as $100/month. If you are ineligible for a premium tax credit on the marketplace, this may be a great option.
The deductible is the amount that you have to pay out of pocket before your insurance begins to contribute to the cost share. However, some services will be covered with a $0 copay even before meeting the deductible. These will likely be more basic services.
There is an inverse relationship between premiums and deductibles. Very often plans with higher premiums will have lower deductibles. These plans may be better if you have more extensive medical needs. Yes, you may pay more on a monthly basis, but it may save you money in the long run if your deductible is lower.
Usually plans with lower monthly premiums have higher deductibles. This may be a good option for you if your needs are not as extensive. Your premiums will be lower, basic services will likely still be covered and you’ll still have an OOP max to protect you-more on that in a moment.
Another added benefit for plans with a higher deductible is the potential use of HSAs. HSAs are health savings accounts.
Copays/Coinsurance
Once you’ve met your deductible, you’ll be responsible for copays or coinsurance when you actually visit the doctor or have a medical procedure.
Copays are a set amount. It might be $25 to visit your PCP and $500 for a specialist. The amounts will be listed on your insurance card.
Coinsurance is a percentage. You’ll be responsible for a percentage of the cost rather than a set amount. This is particularly important in marketplace plans.
Bronze: 60/40
Silver: 70/30
Gold: 80/20
Platinum: 90/10
Your coinsurance and copays will also be affected by your network. If you choose an HMO plan, you will only have coverage in network. If you go out of network (except in case of an emergency), you will be responsible for the full cost. Out of network charges also do not count towards your deductible or OOP max.
If you have a PPO, you will be able to go in and out of network but your copays and coinsurance will be higher if you choose to go out of network.
If you have any further questions, please feel free to contact us here at iHealthBrokers at 888-410-0344 or ihealthbrokers.com/
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