If you have a full-time job, chances are your employer pays for your health insurance. Your contribution through premiums is typically taken straight from your paycheck. Until you need it, you probably don’t give it a second thought.
But what if your employer doesn’t pay for your health insurance? What if you’re self-employed? If you need to find and pay for your own health insurance, it’s important you know how to pay for your health insurance premiums. Learn more now with Benzinga’s guide.
Paying Health Insurance Premiums on HealthCare.gov
Paying your initial premiums on Healthcare.gov is easy if you have access to the internet. It’s as easy as:
- Logging into your Healthcare.gov account
- Choosing your application (You’ll find this under Existing Applications)
- Clicking the blue button that says “Pay Your First Health Insurance Monthly Premium.”
- “Pay for Health Plan Now” (The green button)
If your online payment doesn’t go through, that means your account isn’t ready. Reach out by email or phone to find out what steps you need to take next.
What is Health Insurance?
Like auto insurance covers your car, health insurance is there for you in case you get sick or injured. Typical health insurance policies are sold by most major insurance companies pay for items such as:
- Chronic illness
- Prescription medications
- Psychological services
- Physical and occupational therapy
- Long- and short-term care
Health insurance is there for you if you get sick or or hurt in an accident, but it also covers preventative measures as well, like doctor's visits, screenings and tests. Many policies also offer hearing, vision and dental, although sometimes these can get added on later.
Health insurance isn’t free. For your health insurance, you make payments known as premiums, usually in monthly installments. Even if you have health insurance through your employer, usually you make health insurance payments every month, even though it comes straight out of your paycheck.
When it comes time for you to use your health insurance, it also isn’t free. There are fees and expenses, including:
- Deductibles: Whenever you utilize your health insurance, you’re required to pay a deductible. A deductible is the insured’s contribution toward medical costs. Deductibles are not required every time you use your health insurance, but typically have an annual match-amount. As far as your health insurance costs, the higher the deductible, the lower the premiums — and vice versa. Deductibles reset on an annual basis.
- Copayments: A copay is a flat fee you pay every time you visit your doctor or specialist or receive specific types of healthcare services. Typical copays start around $10 but can go as high as $35. Copays also apply to prescription drug medication, though many health plans do not require a copay when you visit your primary care physician or for prescription medication.
- Coinsurance: First, you pay your deductible, then there’s coinsurance. For example, let’s say your deductible is $500 and your coinsurance is $5,000. If you need an operation, first you pay the $500 deductible. If the procedure costs $50,000 and your coinsurance is 20%, then you pay $10,000 and your health insurance provider pays the remaining $40,000. High coinsurance costs usually equate to lower premiums.
Types of Health Insurance
There are two main types of health insurance: public and private. While public healthcare plans like Medicare and Medicaid are government programs, private plans get paid either by the individual or their employer.
Private health insurance
Private health insurance breaks down into four main categories: HMO, PPO, EPO and POS.
- HMO (Health Maintenance Organization): HMOs have their own networks of hospitals, doctors and healthcare providers. HMO policyholders must stay within this network to qualify for coverage. Because the insurance company makes deals with providers within the network, HMOs are typically more affordable.
- PPO (Preferred Provider Organization): While with an HMO you must stay within your network, a PPO allows you to choose your own doctor and healthcare providers. With a PPO, you can visit any doctor you wish. Because of these less restrictive requirements, PPOs are more expensive than HMOs, and often come with a higher rate of coinsurance.
- EPO (Exclusive Provider Organization): Like an HMO, an EPO offers a local network of providers for the policyholder to choose from. EPO plans are good for people who don’t foresee using their health care so often. EPOs offer higher deductibles and more affordable premiums.
- POS (Point-of-Service Plan): A POS is a managed healthcare plan that’s sort of a hybrid between an HMO and a PPO. Like an HMO, the policyholder has an in-network list of providers. The policyholder must pay for providers not in-network, but what makes a POS different from an HMO is that it will pay for services outside the network if a referral gets made by their primary care physician.
Public health insurance
Public health insurance includes all types of coverage provided by the government: federal, state and local. The main types of public health insurance include:
- CHIP (The Children’s Health Insurance Program)
- VA (Veterans Administration)
- IHS (Indian Health Service)
While Medicare is a federal program for senior citizens 65 years or older (and the long-term disabled), Medicaid is free for those who qualify and gets administered at the state level. CHIP is available to the children of low-income families who do not qualify for Medicaid. The Veterans Administration provides medical assistance to eligible veterans of the United States military, while CHAMP-VA, administered by the Department of Veterans Affairs, covers veterans, their dependents and survivors as well.
Other state and locally administered health services are offered through publicly-run hospitals and clinics. While not technically health insurance, they do offer financial assistance and medical to those who qualify.
What is a Health Insurance Premium?
Your health insurance premium is the amount you pay every month for your health insurance. The amount you pay depends on:
- Your age
- Your health
- Type of plan
- Habits like drinking and smoking
- Amount of coverage
- Amount of deductible
Health insurance gets its funding through your monthly premiums, but the premiums don’t cover everything. On top of premiums, when you use your insurance you have to pay an annual deductible.
There is also coinsurance and copays. The price of your premiums can sometimes get lowered with a premium tax credit. If you have Medicare, you might qualify for the Medicare Savings Plan which pays for part or all of your monthly premiums.
Who Pays Your Health Insurance Premiums?
Who pays your health insurance premiums depends on what kind of insurance you have. If you have a group policy like through your employer, your employer pays your insurance premiums with funds from your paycheck. If you have an individual policy, you pay the premiums.
If you have public health insurance like Medicare Part A, hospitalization is free. Parts B and D (medical services and prescription medication) get paid by the recipient. Public health insurance like Medicaid is free, but hard to qualify for. Even if you don’t qualify for Medicaid, your child may be eligible for CHIP.
Advantages of Lump-Sum Health Insurance Payments
Lump-sum health insurance is now more popular than ever. Lump-sum payments increase efficiency and quality of care. Lump-sum payments help improve coordination between medical facilities and make cancer screenings and treatments more efficient and affordable. Lump-sum payments help to lower deductibles and out-of-pocket expenses.
Lump-sum payments also help those who suffer injury or a debilitating illness like a sudden heart attack or stroke. Prepayment allows the policyholder to focus 100% on recovery, not paying the bills and wondering if they’ve paid their premiums.
It also helps defer costs at the time like deductibles and coinsurance. Cash benefits get paid directly to the insured and can be used as the policyholder sees fit. Lump-sum health insurance premiums help cover:
- Prescription medication
- Unexpected expenses
Cash benefits can even pay household expenses such like rent, mortgages and utilities while the insured is incapacitated.
Compare Health Insurance
When it comes to comparing health insurance premiums, knowledge is king. Benzinga has a wide array of articles on health insurance, everything from what to look for in an insurance policy, which type of insurance is best for you and most importantly, how to keep those health insurance premiums down.
In the end, no matter how good the policy is, if you can’t meet your monthly premiums, you may get left holding the bag. Compare health insurance plans below.
Health Insurance Educational Guides
Whether you’re looking for private health insurance, the time has come to sign up for Medicare or you’re in need of temporary help now, Benzinga has endless articles and educational guides on health insurance and health insurance premiums. Check out these great health insurance educational guides from Benzinga.
Frequently Asked Questions
Why is my monthly health insurance premium so high?
If your health insurance premium is unusually high, maybe you should shop around. Spending time on getting the best deal is not a waste of time at all. Unfortunately, if you are in a high-risk category, even price shopping may not bring down your premiums. If you’re chronically ill, if you have pre-existing conditions or are a smoker, your premiums will naturally be high. Some states have higher monthly premiums too.