Hotly debated in politics, health insurance can be so confusing that we often do not understand how it ultimately works. Health insurance helps cover medical expenses related to illness, injury and overall wellness. This includes doctor visits, medical supplies, surgeries, medications, and even therapies needed for recovery.
Average cost of health insurance
Health insurance premiums are based on two things: age and amount of coverage. Depending on your age, your health insurance can carry a higher premium. The purpose for this discrepancy is to avoid targeting people with pre-existing medical conditions as uninsurable and by allowing enough money in the insurance companies’ accounts to cover illness as they become more prevalent, which occurs as people age. In the same vein, the less money you wish to put out of pocket when dealing with medical issues, the more you will pay for insurance.
That being said, the average monthly premium for health insurance for an individual falls into these average ranges:
- Under 18 years of age:around $150 per month
- 18 to 24 years of age: around $180 per month.
- 25 to 34 years of age: around $240 per month
- 35 to 44 years of age: around $300 per month
- 45 to 54 years of age: around $400 per month
- 55 to 64 years of age: around $580 per month
These premiums are typically based on the lower levels of coverage. As coverage increases, the premiums will rise. Therefore, a person aged 35 to 44 years of age that wants the platinum insurance plan may pay over $600 or more a month, as opposed to the person in that age range with the bronze plan who may be paying only $300 per month.
Average cost of health insurance for a family
Prior to the Affordable Care Act (ACA), health insurance could be purchased as an individual plan or a family plan. Family plans often included the cost of the primary holder and then a group rate added for up to four children. Under the Affordable Care Act, family policies are no longer priced in this fashion. In today’s market, the cost of a family health insurance plan is directly related to how many members are in the family and their ages. Therefore, a family of four (with two adults aged 35 to 44 and two children under 18) could opt for a bronze level insurance plan and pay $900 per month for health insurance.
Many employers, however, offer health insurance coverage in which they pay a percentage of the premium, leaving the insured to pay a much lower amount for health insurance. Therefore, under an employer policy, this same coverage may cost the employee $450 a month or less, depending on the percentage of the premium the employer pays. Larger corporations typically receive higher discounts from insurance companies to offer insurance to their employees. For instance, a company like Amazon might offer a high-deductible health plan to its employees which will cost the employee $99 a paycheck, no matter how many family members are part of the family.
As costly as these benefits may appear, the reality is clear. The cost of healthcare is extremely high. Medical treatment can cost a person without insurance tens to hundreds of thousands of dollars. A simple doctor visit (even a mandated visit required by schools or employment) can cost an uninsured patient over $100. Medication without insurance can cost patients thousands of dollars, depending on the prescription. Attempting to “self-insure” to pay for these expenses when they occur can result in filing for bankruptcy just to get out from the bills. This does not include the government penalties enacted that individuals and families will pay if they do not maintain health insurance. It’s clear that the cost of health insurance is much less pricey than trying to maintain your health without it.
2018 penalties for not having health insurance
Under the new tax bill, the penalty for not having health insurance will disappear in 2019. However, in 2018, the penalty is still intact. Unless you fall into one of several exemptions that have always been part of the Affordable Care Act, the following shows the amount of money you will be fined or penalized for not carrying approved health insurance coverage in 2018.
- Adults 18 years of age and older will pay either $695 per uninsured adult or 2.5% of your adjusted gross income up to $3,264 (The cost of a bronze plan), whichever is greater.
- Adults will be penalized $325 per child under the age of 18.
Once again, this year will still include a penalty if you are not covered by an approved health insurance plan. However, once 2019 begins, the federally mandated individual penalties will no longer affect those not covered by health insurance. While the government may not mandate a penalty for those who do not carry health insurance, medical services will remain costly, and insurance is the only way to offset the financial burden associated with being sick or injured.
What health insurance covers
When determining the best type of health insurance, it is important to understand what the average health insurance policy will cover. Of course, different policies cover some different issues as needed, though there are standards that every policy must cover by law and tend to cover even without the legal mandates. The obvious coverages include wellness visits to your primary care physician, annual wellness testing based on age requirements, and illness or injury-related medical care expenses if you’re in network or it is an emergency. However, most health insurance policies will cover the following, and more:
- Addiction therapy
- Prescription drugs
- Physical therapy
- Mental health treatment
- Postnatal care
- Necessary surgeries
- Doctor visits
- Urgent care visits
- Emergency medical treatment
- Cancer treatment
- Laboratory tests, such as blood tests and bone marrow testing
- X-rays and other scanning procedures
- Pediatric health care
- Chiropractic care
What will health insurance not cover?
Of course, health insurance is not a catchall for all things that may be related to your health. While it does provide coverage for many things, there are items that most health insurance providers will not cover. Typically, these procedures are deemed medically unnecessary or experimental. Therefore, before making any assumptions that a procedure or medication is covered by your insurance, it is important to read your policy or talk to your insurance provider to determine what your policy covers and what you will have to cover on your own. Some of the more common non-covered procedures include:
- Medically unnecessary plastic surgery
- Fertility treatments
- Experimental treatments and medications
- Over-the-counter medications
- Nursing home care and living
- Weight loss surgery
- Alternative treatments, such as acupuncture
- Adult dental care
- Weight loss treatment
Best health insurance companies
Although health insurance is heavily regulated, companies are still quite competitive. Certain insurance companies are known to offer better coverage options than others. When comparing insurance companies, it’s important to weigh advantages/disadvantages between awards, affordability and even additional coverages. Here are Benzinga’s top picks for best health insurance companies:
The winner of the JD Power award, Kaiser Foundation Health Plan is among the best in the northwest and offers coverage to individuals, families, and companies. The Kaiser Foundation includes options ranging from high-deductible HSA plans to premium co-payment plans, all at affordable rates for both families and individuals. In addition, Kaiser offers a charitable non-profit insurance policy for those who do not qualify for Medicaid but cannot afford the cost of health insurance.
Blue Cross and Blue Shield won the gold award for best health insurance plans. Blue Cross and Blue Shield is one of the few insurance companies that offer health insurance in 37 of 50 states. As well as offering affordable health insurance to most of the United States, Blue Cross and Blue Shield offer wellness programs known as Blue365. This program reimburses members for weight loss and fitness regimens. Although the company is among the largest health insurance providers in the country, its local offices allow members to have a local presence as opposed to contacting a national office.
Cigna Health offers a user-friendly method to purchase health insurance. The website allows you to compare side-by-side policy options, plans and even the addition of dental insurance. Cigna is accepted in every state throughout the United States. However, only 12 of the 50 states offer Cigna’s affordable, convenient insurance options. Cigna’s website is complete with access to doctor information and a mobile app so you can contact a physician when you are away from home.
Employers are still required to offer health insurance to full-time employees. Therefore, rather than considering whether you will carry health insurance or choose to “self-insure,” take the time to determine the best insurance policy for you, your family, and/or your employees. Price may only be one factor to consider.
Other important factors to consider are the coverages offered, whether the plan includes a high deductible, and the way in which you utilize health insurance. A family of four may utilize health insurance much differently than a young adult under age 30 without children or a senior citizen over the age of 65. Therefore, if you are more apt to use wellness benefits, you may wish to consider a higher deductible plan with wellness benefits than one that one that co-pays only without these benefits.
Above all else, when you have questions, find a trusted advisor to ask before making a final decision.