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Health insurance costs can range vastly from state to state.1 Where you live, state and federal laws, income level, age, tobacco use and the specific type of health insurance plan you choose all influence the overarching cost.2 Let’s dive deeper into how health insurance works, how much it costs on average, and what can affect the cost you’ll pay.
In a nutshell, policyholders pay a health insurance company a monthly premium in exchange for protection against the high costs of medical care. It can be expensive to pay healthcare bills entirely out-of-pocket.3
In some instances, certain groups of people are given access to less expensive government healthcare options, depending on age and income level. For example, those over 65 are usually covered by Medicare, while lower-income individuals may qualify for Medicaid.4 If you think you fall into one of these categories, we recommend doing further research to explore your health insurance options.
Medicaid and Medicare are considered public healthcare options because the government offers them. If you do not fall into one of these categories, you may need to consider the costs of private health insurance. You also may be able to get health insurance through your employer, depending on where you work. In this instance, health insurance payments may be taken out of your paycheck directly.
Don’t wait until it’s too late. Help cover yourself and your family with affordable coverage from Aflac.
Premiums aren’t the only cost that can influence how much health insurance is. Let’s review a few more terms to understand what influences the cost of health insurance.
As stated earlier, premium payments vary from plan to plan and keep the health insurance benefits active—even if a claim isn’t currently being made. They function similarly to how home and auto insurance premiums do5
The deductible is the amount of money the health insurance requires you to pay out-of-pocket before your health insurance benefits are accessible. The deductible usually starts over at the beginning of every coverage year.6 Deductibles can range from hundreds to thousands of dollars, so we recommend looking closely at each health insurance plan you are considering.
Copays are a certain dollar value that you agree to pay for healthcare and can help prevent you from paying the entire bill out-of-pocket without any insurance. Copays vary depending on if you are getting preventative care, seeing a specialist, or taking a prescription medication. $20 is a common copay value for a doctor's visit.7
Depending on the health insurance plan you choose, you may be able to start receiving the benefit of copays before the deductible is met. In other cases, you may be required to meet the deductible entirely before copays are accessible.
On the other hand, coinsurance is a certain percentage you agree to pay for healthcare. Percentages vary depending on the type of healthcare you are receiving. Sometimes you will have to pay coinsurance and copays for the same visit, depending on what takes place and what your plan states.8
For example, your health insurance company may agree to pay for 80% of the bill and expect you to pay the remaining 20%. If your doctor’s visit costs $300, your insurance would pay $240, and you would pay the remaining $60. Percentage breakdowns vary from plan to plan.
The maximum-out-pocket limit is the most amount of money you will pay for healthcare in a coverage year before your health insurance starts paying for everything.
At public health insurance companies, the maximum out-of-pocket limit is protected by the Affordable Care Act and changes every year. As of 2024, the limit is $9,450 for individuals and $18,900 for families.9 At private health insurance companies, there may be fewer restrictions around this value. We recommend looking at the fine print within each health insurance plan.
A handful of factors will influence how much health insurance costs for you.
The average health insurance cost isn’t the most helpful analysis since there is so much variety from state to state. However, we understand it’s important to have baseline numbers to consider. Here are a few important values that may help you gauge potential payments:
Health insurance premium prices are usually higher for families than individuals, so that is another crucial factor to consider. For more information regarding the average costs of health insurance, we recommend researching the state you live in and your age.
You can visit the Affordable Care Act (ACA) health insurance marketplace website to find affordable health insurance if you meet the income requirements. Simply go to the website and enter information about your household income and family size in order to find the right plan for you. The ACA marketplace will also let you know if you qualify for Medicaid.
Once you’ve found a health insurance plan that works for you, it’s not uncommon to be left with large chunks of money expected to be paid out-of-pocket.
Aflac offers supplemental insurance that works with your primary health insurance plan to help pay for the costs associated with some surgeries, medication, treatment plans, hospital visits and therapy, depending on the plan you choose. Learn more about our insurance plans so you can maximize your coverage.
1-2, 13 Investopedia - How Much Does Health Insurance Cost. Updated September 13, 2023. https://www.investopedia.com/how-much-does-health-insurance-cost-4774184. Accessed February 20, 2024.
3-8 The Balance - How Does Health Insurance Work. Updated May 16, 2022. https://www.thebalance.com/how-does-health-insurance-work-3306069. Accessed February 20, 2024.
9 HealthCare.gov – Out-of-pocket maximum/limit.https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit. Accessed December 12, 2023.
10-12, 14-16 Money Geek - The Average Cost of Health Insurance in 2022. Updated January 23, 2024. https://www.moneygeek.com/insurance/health/average-cost-of-health-insurance/. Accessed February 20, 2024.
Content within this article is provided for general informational purposes and is not provided as tax, legal, health, or financial advice for any person or for any specific situation. Employers, employees, and other individuals should contact their own advisers about their situations. For complete details, including availability and costs of Aflac insurance, please contact your local Aflac agent.
Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York.
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