What is the Average Cost of Health Insurance Coverage?

The average cost for individual health insurance is $438 a month. This cost may vary depending on where you live and how much coverage you want.

How much does health insurance cost?

According to the Kaiser Family Foundation (KFF), the average health insurance benchmark premium is $438 a month. This figure, from 2022, is down slightly from 2021's average monthly cost of $452. The graph below shows how prices have changed in recent years.

Note that these are just the national averages. Your health insurance costs may vary considerably depending on which state you call home. Below is a table showing the average monthly cost of health insurance by tier and state

These average health insurance premiums are based on the lowest-cost plans that KFF studied. They do not figure in cost-sharing reductions or tax credits, which will be discussed later.

As mentioned earlier, various factors drive cost differences in health insurance by state, which result in different rates. Maryland, for example, has some of the cheapest health insurance in the U.S., at only $242 a month for a Bronze plan. In Vermont, on the other hand, a Bronze plan costs an average $641 a month.

How your health insurance plan tier affects cost

ACA, or "Obamacare", health insurance plans come in four tiers, each named for a different metal: Bronze, Silver, Gold and Platinum. Each tier is based on the "actuarial value" of a plan. Actuarial value is the percentage of costs each tier takes care of versus your out-of-pocket costs.

Bronze plan

• Monthly rate: $342
• Covers: 60% of costs, you pay 40%

Bronze plans are the least expensive of the four health insurance tiers in terms of premiums. However, out-of-pocket costs are comparatively high. Bronze plans work best if you don't go to the doctor often and aren't on a long prescription drug regimen.

Silver plan

• Monthly rate: $448
• Covers 70% of costs, you pay 30%

This health care plan tier often works best if you qualify for programs such as cost reductions and tax credits toward health coverage. These programs often help decrease your overall medical costs. If you're not eligible for these programs, the Gold plan is often a good investment.

Gold plan

• Monthly rate: $503
• Covers 80% of costs, you pay 20%

Gold plans are geared toward people who visit the doctor frequently or otherwise require constant medical aid. Your monthly rate will cost more, but you also will hit your deductible limit faster than the lower-tier plans. In the long run, this may be cheaper for covered care than you would pay with a Bronze or Silver tier plan.

Platinum plan

Platinum tier plans offer the best actuarial value/out-of-pocket cost ratio of all the plans. They pay 90% of your medical claims before deductibles, and your out-of-pocket cost is the remaining 10%.

Despite this, they're not popular. People looking for health insurance tend to avoid them due to their incredibly high premiums. As such, accurate average costs for them are not available.

The table below shows the actuarial and out-of-pocket percentages for each tier.

Catastrophic health insurance plans

For qualifying Americans under the age of 30, catastrophic plans are available to provide what can be considered last-resort health insurance. Catastrophic plan premiums are lower than even Bronze tier plans. However, you pay more for visits and prescriptions due to high deductibles.

Factors that affect your health insurance costs

The cost of your health insurance plan depends on what your policy limits are, along with some factors specific to you. These include:

Your premium

Your health insurance premium is the amount you pay for coverage either monthly or annually.

Deductible

This is the amount you agree to pay out on a health insurance claim before your policy pays out its part. The higher your health insurance deductible, the lower your premium will be.

Coinsurance

This is an amount you pay for a medical treatment or service after your deductible limit has been reached. This amount is often a percentage rather than a fixed fee. For example, say you have a 20% coinsurance rate and a $3,000 deductible. If you have a $10,000 treatment, you'd pay 20% of the remaining $7,000 after the deductible is hit.

Copayment

This is a fixed rather than a percentage amount you pay for a health care service after your deductible is hit. Average copayment costs often come in at $10 to $20 per visit.

Out-of-pocket maximum

This amount is the most you pay in a given year for health services under your policy. Once your out-of-pocket limit is reached, your health insurance provider pays for all covered services for the remainder of the year. Deductible costs, as well as all coinsurance and copayment fees you pay during the year, go toward hitting the maximum.

For 2022, all Affordable Care Act marketplace plans have an out-of-pocket maximum of $8,700 for individuals and $17,400 for families.

Along with the above health care policy factors, there are other influences based on you personally. They include:

• Your age
• Annual income
• How much coverage you want
• The number of family members under your policy

Other health insurance options and their costs

There are other health insurance coverage options besides marketplace insurance plans, too. There are plans available for purchase from private insurance providers, health care coverage you get from your job and even ways to continue your coverage if you are unemployed.

Private health insurance

If you aren't purchasing health insurance through the ACA marketplace, insurers have non-ACA regulated health insurance available as well. Private health insurance plans may have benefits that marketplace plans do not.

For example, you may see a shorter wait time for treatment, which is good when you're looking at elective surgery. Going through a broker that can provide options both on and off the marketplace can give you a wider range of choices for your health care as well.

There are also some potential downsides with non-ACA plans. Cost is a big one. With ACA health insurance, you might qualify for tax credits or other income-based savings not available with private health insurance plans. These health care tax credits help lower your insurance costs by either paying part of your premium or providing a tax return refund.

Costs vary a great deal with private insurers on a state-by-state basis, making locking down an average cost difficult. To see what private insurers offer in your state, you can compare quotes from multiple health insurance providers.

Employer-based health insurance

According to the Kaiser Family Foundation, the average premiums paid for employer-provided health insurance were $7,911 for single coverage and $22,463 for family coverage in 2022. What you pay depends on how much of the premium your employer covers.

COBRA health insurance

The cost of COBRA health insurance depends on your employer-based health insurance cost, often adding a 2% service fee. COBRA helps maintain your health care coverage if you lose employer-sponsored health insurance.

Consider COBRA if you're happy with your old job's health insurance and can afford it, especially since it can still cover dependents under conditions such as your death or divorce. However, COBRA coverage can often be much more expensive than coverage purchased through the ACA marketplace. Also, COBRA coverage usually has a limited time period of activity, often between 18 and 36 months.

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