Given the skyrocketing inflation and healthcare costs, most Americans are unsurprisingly squeezed between making ends meet and covering life necessities. That’s why health insurance costs are usually the focal point of many conversations.
One of the first questions is. “How much does health insurance cost?” Let’s review the cost breakdown of health insurance and dive into the average costs of health insurance determined by various common factors.
Health Insurance Cost: A Complete Breakdown by Age, Plan Type, Metal Tier, Family Size, Company, and State
What Factors Affect the Health Insurance Cost?
Since insurance providers use multiple factors and chosen types of plans when determining the premiums, the health insurance cost can fluctuate from one person to another. Some of the most common factors to calculator health insurance costs include:
Age
The insured’s age is a significant factor in determining health insurance costs. The rates usually increase as the insured ages, approximately age 55 and above, when they are most likely to pay more for medical expenses due to more significant risks of hospitalization and mortality.
Body Mass Index (BMI)
High BMIs present higher exposure to illnesses and life-threatening conditions. In such a situation, a person mostly has more body fat or is diagnosed with obesity, equating to much higher health-related costs. It’s estimated that obesity increases healthcare and medical expenses by around $15,000 for 50-year-olds.
Medical History
A medical history reflects your past and current state of health, whether you have experienced certain critical illnesses, have received treatments, or have undergone surgeries. It allows insurance providers to understand your overall health better and assess your risks accordingly. Most of the time, expect to pay extra if you have pre-existing conditions, such as asthma, hypertension, diabetes, or cardiovascular disease. Similarly, your premiums will also increase if you have direct family members with a history of serious illnesses.
Health Plan Benefits
The benefits designated for each health plan can make a big difference in health insurance prices. Generally, HMOs and EPOs have the lowest premiums but won’t allow the insured to obtain out-of-network care and services. Conversely, higher-premium plans like POS and PPOs offer greater flexibility when seeking care outside the network. Still, such privilege often comes with higher premiums.
Metal Tiers
The Affordable Care Act marketplace uses tiers to help consumers determine whether they want to pay higher or lower premiums and opt for the best health plans for their budgets. The metal tiers typically include Bronze, Silver, Gold, and Platinum. Bronze and Silver health plans have lower premiums with higher deductibles. In contrast, Gold and Platinum health plans have higher premiums and lower deductibles.
| Bronze | Silver | Gold | Platinum | |
| Cost-splitting ratio (individual costs/insurer costs) | 40/60 | 30/70 | 20/80 | 10/90 |
| Premiums | Lowest | Low | High | Highest |
| Out-of-pocket costs | Highest | High | Low | Lowest |
Location
As the premiums tend to vary from state to state and county to county, residential address or geographic location also plays a role in health insurance costs. Residents from expensive states have higher spending on health insurance premiums, whereas people from the least costly states or rural areas can expect to pay less. Other factors related to location include crime statistics, climate, traffic, pollution, etc.
Occupation
The nature of your work also factors into health insurance rates. Workers with high-risk or hazardous professions may pay more than those who work in safer environments.
Lifestyle Habits
What you do in your free time can significantly impact your premiums. You will pay higher rates if you have a passion for dangerous hobbies like scuba diving, skydiving, rock climbing, long-term tobacco use, or are consuming excessive alcohol. Smoking can cause the premiums to go up by 50%.
Health Insurance Riders
Health insurance add-ons or riders help the insured enhance their benefits and provide extra protection for themselves and their loved ones. However, these additional coverages come at a cost and may raise the cost of health insurance in exchange for extended benefits.
How Much Does Health Insurance Cost by Metal Tier?
The table below shows the monthly health insurance rates and maximum out-of-pocket depending on tiers for a 26-year-old applicant as of 2023.
| Metal Tier Level | 2023 monthly rate | Maximum Out-of-Pocket |
| Catastrophic | $263 | $9,100 |
| Bronze | $335 | $9,060 |
| Expanded Bronze | $353 | $8,453 |
| Silver | $449 | $5,034 |
| Gold | $469 | $7,251 |
| Platinum | $612 | $2,503 |
How Much Does Health Insurance Cost by Plan Type?
The table below shows the monthly health insurance cost by health plan type for a 40-year-old applicant.
| Plan Type | 2022 monthly rate | 2023 monthly rate |
| HMO | $457 | $480 |
| PPO | $522 | $576 |
| EPO | $508 | $507 |
How Much Does Health Insurance Cost by Age?
The table below shows the average cost of health insurance on the ACA marketplace cost by age:
| Plan Member | Average Cost for A Bronze Plan | Average Cost for A Silver Plan | Average Cost for A Gold Plan |
| Adult individuals of age 21 | $313 | $410 | $450 |
| Adult individuals of age 27 | $330 | $433 | $476 |
| Adult individuals of age 30 | $356 | $468 | $514 |
| Adult individuals of age 40 | $401 | $526 | $578 |
| Adult individuals of age 50 | $560 | $736 | $808 |
| Adult individuals of age 60 | $850 | $1,115 | $1,225 |
How Much Does Health Insurance Cost by Family Size?
The table below shows the varying cost of health insurance by family size based on the 40-year-old individual.
| Average Health Insurance Costs | |
| Individuals of age 40 | $447 |
| Couple (2 40-year-olds) | $954 |
| Couple with a kid aged 0-14 | $1,230 |
| Couple with 2 kids aged 0-14 | $1,506 |
| Couple with 3 kids aged 0-14 | $1,782 |
How Much Does Health Insurance Cost by Company?
The table below shows the average monthly health insurance cost by company for a 40-year-old applicant with an expanded bronze health plan.
| Company | Average Monthly Health Insurance Cost |
| Alliant | $324 |
| Kaiser Permanente | $336 |
| Aetna | $380 |
| Friday Health Plans | $392 |
| Oscar | $416 |
| Health Net | $419 |
| Moda Health | $426 |
| Baylor Scott & White | $429 |
| United Healthcare | $433 |
| Ambetter | $440 |
| Cigna | $443 |
| Molina | $445 |
| Blue Cross Blue Shield | $450 |
| Avmed | $574 |
| Wellcare | $793 |
How Much Does Health Insurance Cost by State?
Here is the breakdown of average monthly and annual health insurance costs by state.
| State | Monthly Health Insurance Cost | Annual Health Insurance Cost |
| Alabama | $798 | $9,571 |
| Alaska | $534 | $6,409 |
| Arkansas | $453 | $5,442 |
| Arizona | $582 | $6,979 |
| Delaware | $565 | $6,776 |
| Florida | $591 | $7,096 |
| Georgia | $479 | $5,751 |
| Hawaii | $475 | $5,704 |
| Iowa | $561 | $6,731 |
| Illinois | $564 | $6,767 |
| Indiana | $431 | $5,167 |
| Kansas | $579 | $6,948 |
| Louisiana | $631 | $7,571 |
| Miami | $471 | $5,647 |
| Missouri | $588 | $7,053 |
| Mississippi | $518 | $6,213 |
| Montana | $510 | $6,120 |
| North Carolina | $617 | $7,403 |
| North Dakota | $503 | $6,041 |
| Nebraska | $659 | $7,906 |
| New Hampshire | $457 | $5,489 |
| Ohio | $538 | $6,458 |
| Oklahoma | $636 | $7,627 |
| Oregon | $529 | $6,349 |
| South Carolina | $554 | $6,643 |
| South Dakota | $660 | $7,916 |
| Tennessee | $558 | $6,699 |
| Texas | $592 | $7,110 |
| Utah | $571 | $6,854 |
| Virginia | $390 | $4,679 |
| Wisconsin | $558 | $6,698 |
| West Virginia | $864 | $10,374 |
| Wyoming | $791 | $9,492 |
If you have any questions about how much health insurance costs, please contact us for a free consultation.
LOOKING FOR AFFORDABLE INSURANCE?
Quotetopia matches you with what you’re looking for! We make your search a single step based on coverage and cost information from hundreds of top insurers, connecting you with the best match at the best value. From auto to health to life insurance, Quotetopia has you covered.
