There are several options you must consider when choosing a health insurance plan. Many people receive coverage through their workplace. On the other hand, for the elderly or retired, Medicare (a public health program created by the federal government) might be the most suitable. However, there are also individual plans available from health insurance companies. But, how much is individual health insurance, and what does it cover?
Recently, this option has 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.
Individual Health Insurance is a type of plan where you purchase coverage directly from health insurance companies. It is not offered by your employer and is not 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.
As it pertains to the cost of health insurance, several factors can impact your average costs. Most prominently, this is 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, the plan type you select plays a factor in your monthly premiums and coinsurance rates.
For clarification, a premium is the amount of money you must pay per month 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 the remaining 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.
Health insurance companies will typically charge higher amounts for older policyholders. As stated by MoneyGeek, 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.
We know that cost can be concerning for those who are looking to purchase an individual health plan. It should be stated that 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 terms provided by the ACA (Affordable Care Act). This means that they must provide 10 Essential Health Benefits.
Depending on your state of residence, you might be able to purchase short-term medical insurance. With this option, you can choose to have 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.
Some might be concerned about not having employer-sponsored insurance. This option may seem more straightforward as your company is providing you with a list of coverage options to choose from. However, with the help of an insurance agent, an individual plan can be more cost-effective.
The Affordable Care Act, more commonly known as Obamacare, is a reform law established by the federal government. This act aims to make health more affordable and easier to access.
The ACA increased the coverage rate for millions of individuals. In addition to this, 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, meaning that you can budget your health insurance costs accordingly.
While many employers offer group health plans, some companies may offer an HRA. With this option, your employer will reimburse the costs for 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 simply reject their insurance offer.
Depending on the state you live in, you may be paying more or less than the national average for health insurance. No two plans from the Health Insurance Marketplace are identical.
As stated by MoneyGeek, 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 per month.
This may be because certain states are not employing CSRs (cost-sharing reductions). Without CSRs, many insurance policyholders must pay higher costs.
There are a variety of differences between Individual and Group Health Insurance. For many, an individual health insurance plan is the more suitable option.
Individual Health Insurance
Group Health Insurance
Individual Health Insurance is typically more expensive as the policyholder must fully pay the monthly premiums. The price may vary depending on which plan you choose from the Health Insurance Marketplace.
Group Health Insurance is the less expensive option. This is because the costs are spread amongst all eligible members.
With a pre-existing medical condition, an individual may not be eligible for certain coverage plans. Health insurance companies will determine this.
Group health plans are available to all qualifying members. Pre-existing medical conditions are not a factor.
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.
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
An individual has the ability to choose their own plan from the Health Insurance Marketplace. They can find a plan that best meets their financial situation.
An individual will have fewer options. This is because their company will offer them a limited selection of coverage plans.
There are four types of health insurance plans: EPO, PPO, HMO, and POS. It is important to understand what these plan types are, as they each have different coverage intricacies. All plans must comply with federal government guidelines.
Under this plan type, an individual must go to doctors and hospitals in-network. Otherwise, their services may not be covered.
Contrastingly, with a PPO plan, you can still stay with the doctor of your choosing, even if they are out of network. However, it will be more expensive compared to finding a doctor in your insurance company’s network.
Under an HMO plan, you may be limited to doctors that are in-network only. Similar to an EPO plan, out-of-network services may not be covered.
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.
If you are interested in learning 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 to 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 works best for your needs. We look forward to hearing from you.
This will depend on your income level and insurance plan type. As stated by Statista, in 2020, the average policyholder spent 11.6% of their income towards health insurance premiums and deductibles.
No, it is actually quite less than what most people pay 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 option.
Without insurance, a doctor's visit can cost hundreds of dollars. However, with insurance, a typical copayment is exponentially less expensive.
As of 2023, the out-of-pocket maximum for an individual policyholder cannot exceed $9,100.
Generally, once you reach your out-of-pocket maximum, your health insurance company will cover all services in full.