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Life is full of puzzles. Is a hot dog a sandwich? Why is ranch dressing so popular? Why is health insurance so confusing? While we can’t say why health insurance is so complicated, we can shed some light on private health insurance (also known as Private medical insurance). Read on to learn what it is, how to buy a policy and which plans are the best.
Best Private Health Insurance:
- Best for Travel: Blue Cross Blue Shield
- Best for HMO: Kaiser Permanente
- Best for Seniors: UnitedHealthcare
- Best for Preventive Care: Molina Healthcare
- Best for Availability: Cigna
Private vs. Public Health Insurance
What’s the difference between private and public health insurance? Let’s take a closer look.
- Public: Public health insurance is funded and supported by a federal or state government. In the U.S., the 2 most common public health insurance plans are Medicare and Medicaid. It’s important to note that you may have to pay for public health insurance. For example, people with Medicare pay a premium for Part B.
- Private: Private health insurance is insurance that isn’t offered by the federal or state government. You can purchase private health insurance through an employer, through your state’s Marketplace or directly from an insurance company.
Both types of health insurance have out-of-pocket costs.
How Much Does Private Health Insurance Cost?
Insurance companies decide on premiums based on several factors. These include:
- Your age: The older we are, the more likely we are to need healthcare. To account for this, insurance companies charge higher premiums to older plan members.
- Whether you use tobacco: Smoking and using tobacco increases the risk of developing health issues.
- Your location: Where you live has an impact on your health. It also impacts how much competition there is among insurance companies and how expensive it is to provide healthcare.
- The number of people on your plan: An individual plan is less expensive than a family plan.
Insurance companies can’t charge you a higher premium based on your gender or on your specific health history. You can’t be charged a higher rate if you have diabetes, for example.
Many people get private health insurance through an employer. Employers typically pay for part of the costs of health insurance and employees pay for the rest. Employees paid an average of $1,427 annually for individual coverage in 2018, according to The Commonwealth Fund. They paid an average of $5,431 for a family plan. This comes to $118 per month for an individual plan and $452 per month for a family plan.
Private health insurance purchased on your own (not through an employer) is significantly more expensive. According to eHealth Insurance, the average cost of an individual plan purchased on your own is $440 per month. The average cost of a family plan is $1,168. This comes to $5,280 per year for an individual and $14,016 per year for a family.
The first step to finding affordable health insurance is getting multiple quotes. Here at Benzinga, we have a simple tool that allows you to get quotes fast by entering your ZIP code. As you review your quotes, keep in mind that every insurance company determines its rates differently. The cost of health insurance is about more than just your premium, though. Here are a few other costs to consider:
- Deductible: Your deductible has a big influence on your health costs. Your deductible is the amount you pay for covered health care before your plan starts paying. The average deductible in 2018 was $4,328 for an individual plan and $8.352 for a family plan, according to eHealth Insurance.
- Copayment: Your copayment, or copay, is a fixed amount you pay for a service. You might have a $10 copay for a doctor’s visit and a $20 copay for a specialist visit.
- Coinsurance: Coinsurance is like a copay, but instead of paying a fixed amount, you pay a percentage of the cost. If your plan has a coinsurance of 20% and your doctor visit costs $200, you would pay $40.
- Out-of-pocket maximum: Your out-of-pocket maximum is the most you pay would pay out-of-pocket in a year. This total doesn’t include your premiums. Plans sold on your state’s health insurance Marketplace have a maximum out-of-pocket limit of $8,200 for individual plans as of 2020. The maximum out-of-pocket limit for family plans is $16,400.
HMO vs. PPO vs. EPO vs. POS
Another factor to consider when it comes to how to get health insurance is the plan type. Here are the 4 most common types of plans:
- HMO: An HMO is a health maintenance organization. With an HMO, you choose a primary care doctor. If you need to see a specialist, you typically need to get a referral from your primary care provider. HMOs have a provider network. You may not be able to see providers outside of your network. If your plan allows you to see out-of-network providers, you will have to pay more.
- PPO: A PPO is a preferred provider organization. It allows you more flexibility than an HMO. You typically don’t need a referral to see a specialist. You can see providers outside of the provider network, but you will pay a bit more.
- EPO: An EPO is an exclusive provider organization. It combines aspects of an HMO and a PPO. You have the more restrictive network associated with an HMO. If you see an out-of-network provider, you pay significantly more. You also have the freedom to see specialists without a referral.
- POS: A POS is a point-of-service plan. You can see any provider in your network without getting a referral. If you want to see an out-of-network provider, you do need a referral.
Best Private Health Insurance Right Now
Choosing private health insurance is a big decision. You can get multiple quotes fast through our website, but which plans are the best? Here are the 5 best health insurance companies, based on our research:
1. Best for Travel: Blue Cross Blue Shield
If you’re someone who travels for work or who splits time between locations, Blue Cross Blue Shield might be the plan for you. Blue Cross Blue Shield has plans and network providers in every state.
It also has coverage options if you travel or live overseas. Blue Cross Blue Shield is made up of independent companies, so you choose a plan that serves your area and let the local company know about your travel or other needs.
2. Best for HMO: Kaiser Permanente
Kaiser Permanente isn’t available everywhere, but if you’re in one of its service areas, it’s worth a look. Kaiser Permanente is unique in that it’s both an insurance plan and a care provider. This means better coordination when it comes to your care.
In some of Kaiser’s service areas, you can go to a Kaiser facility for routine care. You can see multiple providers and pick up prescriptions all in the same place.
3. Best for Seniors: UnitedHealthcare
Do seniors need private health insurance? Most of them have Medicare, right? Medicare covers a lot, but it has a lot of out-of-pocket costs, too. Many seniors purchase a private Medicare Supplement or Medicare Advantage plan to work with their public Medicare coverage.
UnitedHealthcare has partnered with AARP to offer a variety of plans for seniors. It offers Medicare Advantage plans, which typically have low premiums and include prescription coverage. It also offers Medicare Supplements, which typically have higher premiums but lower deductibles.
4. Best for Preventive Care: Molina Healthcare
Molina Healthcare has been in business since 1980. It was founded by a doctor to serve the needs of low-income patients. Today, Molina serves patients of all income levels with an emphasis on preventive care and wellness.
It has an extensive network of providers and hospitals. Its plans provide affordable coverage for your day-to-day healthcare needs.
5. Best for Availability: Cigna
Some insurance companies can be a challenge to contact. They might only be available during business hours, which is when most of us work.
Cigna is available 24/7, which makes it easy to talk to someone when you need to. It also offers a user-friendly mobile app so that you can access your insurance info on the go. Cigna offers affordable copays and low-cost preventive care.
Finding a Private Health Insurance Plan
Finding the best health insurance can feel like a process. At Benzinga, we want to help you make smart decisions about your insurance. Our simple online quote engine connects you with multiple insurance providers so you can choose a plan that works for you. All you need to do is enter your ZIP code and click Get Quote.
As you review plans, keep your priorities in mind. If you have a doctor you like, look for a plan that has your doctor in-network. If you take prescriptions, find out whether your prescriptions are covered. If you want low premiums, keep an eye on the deductible to make sure you don’t end up with unexpected out-of-pocket costs.
Choosing an insurance plan is a balancing act. You want it to fit your budget and your health needs. You want good service and convenient care. Look for a plan that fits your lifestyle, and don’t hesitate to ask questions along the way.