There are several options you must consider when choosing a health insurance plan. Many people receive coverage through their workplace. On the other hand, Medicare (a public health program created by the federal government) might be the most suitable for the elderly or retired. However, there are also individual plans available from health insurance companies. But how much is individual health insurance, and what does it cover?
This option has recently gained traction as it provides greater customization opportunities and flexibility within different plans. In the following, we will explain what individual health insurance is, how much it costs, and why it might be the right choice for you.
Why Consider Getting Individual Health Insurance
Individual Health Insurance is a plan for purchasing coverage directly from health insurance companies. It is not offered by your employer or operated by the federal government.
There are specific benefits you receive when purchasing individual health insurance. On top of coverage customization and flexibility, you can also receive premium tax credits.
Health Plans of NC has an expert staff of licensed health insurance agents who can provide you with all the proper information.
How Much Individual Health Insurance Costs in 2023
As it pertains to the cost of health insurance, several factors can impact your average costs. Most prominently, these are age, medical history, and plan tier. Monthly premiums are typically higher for older policyholders. In addition, tobacco usage can also raise one’s premium. Finally, your plan type affects your monthly premiums and coinsurance rates.
For clarification, a premium is the amount you must pay monthly to receive coverage. A missing payment can result in a lapse of coverage. Therefore, it is quite important to confirm that your premium is affordable. Coinsurance is the percentage split between both you and your health insurance company. For example, you might pay 20%, and your insurance company will pay 80%.
There are four different health insurance plan tiers: Bronze, Silver, Gold, and Platinum. With a Bronze plan, you pay the lowest monthly premium but have the highest coinsurance rate. Contrastingly, a Platinum member will pay the highest monthly premium but have the lowest coinsurance rate.
The Average Cost of Health Insurance by Age
Health insurance companies typically charge higher amounts for older policyholders. As MoneyGeek states, a 26-year-old policyholder will pay $372 per month for insurance. This amount rises significantly to $970 per month for a 60-year-old policyholder. However, despite paying more, elderly members can receive higher insurance subsidies.
Request a free quote to see how much your plan may cost.
Get Your Individual Health Plan For Less
We know that cost can be concerning for those looking to purchase an individual health plan. However, there are ways to mitigate your average costs. You can purchase an “off-exchange” policy or short-term medical insurance. These are important terms to know as they can help you save money.
An “off-exchange” policy is one that you purchase directly from the insurance company or broker. In addition, all these plans must comply with the ACA (Affordable Care Act) terms. This means that they must provide 10 Essential Health Benefits.
Depending on your residence, you can purchase short-term medical insurance. With this option, you can choose coverage anytime from 1 to 12 months. This is a viable option for adults who have reached the age of 26 and no longer qualify as dependent.
Individual Health Coverage Can Save You Money
Some might be concerned about not having employer-sponsored insurance. This option may seem more straightforward as your company provides you with a list of coverage options. However, with the help of an insurance agent, an individual plan can be more cost-effective.
Affordable Care Act
The Affordable Care Act, more commonly known as Obamacare, is a reform law established by the federal government. It aims to make health care more affordable and easier to access.
The ACA increased the coverage rate for millions of individuals. In addition, it ensured that any family or individual plan from the Health Insurance Marketplace offers maternity care and mental health services. Furthermore, monthly premiums have become more stable, so you can budget your health insurance costs accordingly.
Health Reimbursement Arrangement
While many employers offer group health plans, some companies may offer an HRA. With this option, your employer will reimburse covered medical services and procedures. This can also include paying a portion of your monthly premium or out-of-pocket costs.
It should be noted that there is no coverage requirement. Therefore, your employer will decide how much they will reimburse you. Typically, companies want an HRA plan to be affordable. Otherwise, employees can reject their insurance offer.
Health Insurance Marketplace by State
Depending on your state, you may be paying more or less than the national average for health insurance. No two plans from the Health Insurance Marketplace are identical.
MoneyGeek states that on average, a person living in North Carolina will pay a monthly premium of $617. Alternatively, policyholders residing in West Virginia pay an average of $864 monthly.
This may be because certain states are not employing CSRs (cost-sharing reductions). Without CSRs, many insurance policyholders must pay higher costs.
Which is Better? Individual or Group Health Insurance?
There are various differences between Individual and Group Health Insurance. For many, an individual health insurance plan is the more suitable option.
Individual vs. Group Health Insurance
Factor | Individual Health Insurance | Group Health Insurance |
Cost | Individual Health Insurance is typically more expensive as the policyholder must fully pay the monthly premiums. The price may vary depending on your chosen plan from the Health Insurance Marketplace. | Group Health Insurance is the less expensive option. This is because the costs are spread amongst all eligible members. |
Availability | An individual may not be eligible for certain coverage plans due to a pre-existing medical condition. Health insurance companies will determine this. | Group health plans are available to all qualifying members. Pre-existing medical conditions are not a factor. |
Coverage | This type of plan provides coverage for the policyholder and their family members. | This type of plan provides coverage for all qualifying members of a company. |
Portability | An individual can stay under their current plan if they change jobs. | Your company may no longer provide coverage if you leave your job. |
Choice of Plan | Individuals can choose their own plan from the Health Insurance Marketplace, finding one that best meets their financial situation. | An individual will have fewer options because their company offers them a limited selection of coverage plans. |
The Types of Individual Health Insurance Plans
There are four types of health insurance plans: EPO, PPO, HMO, and POS. It is essential to understand these plan types, as they each have different coverage intricacies. All plans must comply with federal government guidelines.
EPO (Exclusive Provider Organization)
Under this plan type, an individual must go to doctors and hospitals in-network. Otherwise, their services may not be covered.
PPO (Preferred Provider Organization)
Contrastingly, with a PPO plan, you can stay with the doctor you choose, even if they are out of network. However, it will be more expensive compared to finding a doctor in your insurance company’s network.
HMO (Health Maintenance Organization)
Under an HMO plan, you may be limited to in-network doctors only. Similar to an EPO plan, out-of-network services may not be covered.
POS (Point of Service)
With this option, you will pay less if you choose doctors and specialists that are in-network. It is important to note that you may need a referral from your doctor before you visit a specialist, although referrals are more common with HMOs.
I Want an Individual Health Insurance Plan: What Should I Do?
If you want to learn more about an individual health insurance plan, contact us at Health Plans of NC. Our hours of operation are 8 AM to 5 PM, Monday through Friday, and our phone number is 800-797-0327. We have an excellent staff of experienced health insurance agents who can help you find the plan that best suits your needs. We look forward to hearing from you.
Frequently Asked Questions
How much of your paycheck should go to health insurance?
This will depend on your income level and insurance plan type. According to Statista, in 2020, the average policyholder spent 11.6% of their income on health insurance premiums and deductibles.
Is $200 a month a lot for health insurance?
No, it is quite less than what most people pay for health insurance.
Is it cheaper to pay out of pocket for health insurance?
This depends on which state you live in and the type of plan your employer is offering. For many, purchasing an individual health insurance plan is the more affordable.
How much is a doctor's visit without insurance in 2023?
Without insurance, a doctor's visit can cost hundreds of dollars. However, with insurance, a typical copayment is exponentially less expensive.
What is a good out-of-pocket maximum for insurance?
As of 2023, the out-of-pocket maximum for an individual policyholder cannot exceed $9,100.
Do co-pays go away after you reach your out-of-pocket maximum?
Generally, once you reach your out-of-pocket maximum, your health insurance company will fully cover all services.