Cost of medical insurance for family of 4

When choosing a plan, it’s a good idea to think about your total health care costs, not just the bill (the “premium”) you pay to your insurance company every month.

Other amounts, sometimes called “out-of-pocket” costs, have a big impact on your total spending on health care – sometimes more than the premium itself.

Beyond your monthly premium: Deductible and out-of-pocket costs

• Deductible: How much you have to spend for covered health services before your insurance company pays anything (except free preventive services)
• Copayments and coinsurance: Payments you make each time you get a medical service after reaching your deductible
• Out-of-pocket maximum: The most you have to spend for covered services in a year. After you reach this amount, the insurance company pays 100% for covered services.

How to estimate your yearly total costs of care

In order to pick a plan based on your total costs of care, you’ll need to estimate the medical services you’ll use for the year ahead. Of course it’s impossible to predict the exact amount. So think about how much care you usually use, or are likely to use.

• Before you compare plans when you’re logged in to HealthCare.gov or preview plans and prices before you log in, you can choose each family member’s expected medical use as low, medium, or high.
• When you view plans, you’ll see an estimate of your total costs — including monthly premiums and all out-of-pocket costs — based on your household’s expected use of care.
• Your actual expenses will vary, but the estimate is useful for comparing plans’ total impact on your household budget.

Total costs & “metal” categories

When you compare plans in the Marketplace, the plans appear in 4 “metal” categories: Bronze, Silver, Gold, and Platinum. The categories are based on how you and the health plan share the total costs of your care.

Generally speaking, categories with higher premiums (Gold, Platinum) pay more of your total costs of health care. Categories with lower premiums (Bronze, Silver) pay less of your total costs. (But see the exception about Silver plans below.)

So how do you find a category that works for you?

• If you don’t expect to use regular medical services and don’t take regular prescriptions: You may want a Bronze plan. These plans can have very low monthly premiums, but have high deductibles and pay less of your costs when you need care.
• If you qualify for "cost-sharing reductions" (CSRs): Silver plans may offer good value. If you qualify, your deductible will be lower and you’ll pay less each time you get care. But you get these extra savings only if you enroll in Silver. If you don’t qualify for CSRs, compare premiums and out-of-pocket costs of Silver and Gold prices to find your right plan. See if your income estimate falls in the range for cost-sharing reductions.
• If you expect a lot of doctor visits or need regular prescriptions: You may want a Gold plan or Platinum plan. These plans generally have higher monthly premiums but pay more of your costs when you need care.

Whether you’re in charge of a household or single and in charge of only yourself, most of us have a budget. Each month we hold ourselves accountable to pay for rent, utilities, groceries, car expenses, credit card bills, and more. While some of these obligations are easy to estimate, the cost of medical care can be a little trickier. 

Below are several factors that influence healthcare premiums and will help you determine how much health insurance may cost per month.

How Much Is Health Insurance per Month for One Person?

Monthly premiums for Affordable Care Act (ACA) Marketplace plans vary by state and can be reduced by subsidies. The average national monthly health insurance cost for one person on an Affordable Care Act (ACA) plan without subsidies in 2022 is $438.1 

Wondering how insurance premiums are decided? The Affordable Care Act ensures that insurance companies cannot discriminate based on gender, current health status, or medical history. Here are factors that determine health insurance premiums. 

Age

While some states, specifically New York and Vermont, do not use age when determining health insurance premiums, this is a major contributing factor for most states. 

The age of 21 is used as the base age, with premium costs being adjusted upwards for those in their thirties, forties, fifties, and sixties. Around age 53, the premium rate becomes more than double the base rate.

Tobacco

Tobacco use will affect how much health insurance costs you per month. In fact, health insurance companies can charge smokers up to 50% more than non-tobacco users. While some states have elected not to allow insurance carriers to charge smokers the maximum allowed, tobacco use does still affect pricing. 

Location 

Location affects the price of the premiums, too, mostly due to the amount of (or lack of) competition in a particular area or region. While competition can be intense in populated areas, rural parts of the country may only have one or two insurance companies, making pricing higher for these residents.

Plan Category

Finally, your choice of plan will also influence the average health insurance cost per month. Plans are broken down by metal tiers: Bronze, Silver, Gold, Platinum and Catastrophic. Each carries different premiums based on what percentage of overall healthcare costs they cover. Premiums are also affected by the plan’s deductibles, copays, coinsurance, and number of family members on the plan.

The national average health insurance premium for a benchmark plan in 2022 is $438, according to the Kaiser Family Foundation.1 A benchmark plan is the average premium for each state’s second lowest cost silver plan.

The following data reflects the national average, and each state’s average, but does not include any reduction in cost from subsidies. Rates will vary by area.1

Average Monthly Health Insurance Premiums for Benchmark Plans by State Without a Subsidy

How Much Does Health Insurance Cost per Month in Each State With a Subsidy?

The estimated national average cost in 2022 for a silver plan after a premium subsidy* is applied is $66.72. This chart, unlike the previous one, takes into account subsidies. Here, you can find the average monthly premium with subsidies, for a benchmark silver plan in a select city within your state. 

Monthly Health Insurance Rates by State With a Premium Subsidy2

(40-year-old making $30,0000 per year)

How Much Is Family Health Insurance per Month?

The average monthly premium for employer-sponsored family health coverage in 2021 was $1,851.75, according to the Kaiser Family Foundation.3 Like individual insurance, your family cost will depend on ages, location, plan category, tobacco use, and number of plan members. 

What Is the Least Expensive Health Insurance?

As you can see from the factors listed above, there’s a lot that goes into determining the price of insurance. There isn’t a single healthcare plan that’s right for everyone. But finding the right plan for your needs can be easy with HealthMarkets. You can shop online, compare healthcare plans, and apply in minutes. You can also call (888) 986-2752 to speak with a licensed insurance agent.

46698-HM-0222
* Subsidy amounts are based on a 40-year-old nonsmoker making $30,000 per year.

References:
1. “Marketplace Average Benchmark Premiums.” KFF. 2022. Retrieved from https://www.kff.org/health-reform/state-indicator/marketplace-average-benchmark-premiums/?currentTimeframe=0&selectedDistributions=2022&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D | 2. “How ACA Marketplace Premiums Are Changing by County in 2022.” KFF. December 2021. Retrieved from https://www.kff.org/private-insurance/issue-brief/how-aca-marketplace-premiums-are-changing-by-county-in-2022/ | 3. “2021 Employer Health Benefits Survey.” KFF. November 2021. Retrieved from https://www.kff.org/health-costs/report/2021-employer-health-benefits-survey/