In 2023, the average cost of health insurance for a family of four was approximately $23,968 per year. It’s important to note that health insurance costs can vary significantly depending on factors such as location, plan type, and coverage options. Families should carefully consider their specific healthcare needs and budgetary constraints when selecting a health insurance plan to ensure they choose an option that provides adequate coverage while remaining financially manageable. Additionally, exploring available subsidies or employer-sponsored plans can help offset some of the expenses associated with family health insurance coverage.
Calculating family health insurance costs
Calculating the cost of family health insurance involves several factors including coverage options, age of family members, geographical location, and the number of family members covered. Here’s a basic overview of how these factors impact the cost:
- Coverage Options: The level of coverage (e.g., basic, comprehensive) significantly impacts premiums. More comprehensive plans with lower deductibles and more benefits (like dental or vision) will cost more.
- Age of Family Members: Typically, premiums increase with the age of the policyholder. The older the family members, especially the primary policyholder, the higher the premiums.
- Region: Health insurance costs can vary depending on the state or region due to differences in cost of living, state regulations, and competition among insurers.
- Family Size: Generally, adding more members to a policy increases the total premium. However, some policies may offer a reduced incremental cost for additional family members.
Factors affecting insurance costs
In the complex world of health insurance, several key factors such as age, location, type of coverage, and lifestyle choices play a pivotal role in determining the cost of insurance premiums.
Coverage
Plans offered on the Marketplace are categorized into metallic tiers: Bronze, Silver, Gold and Platinum to help consumers choose plans based on cost. The metallic tier reflects the value of the coverage, or how health plans and enrollees split the healthcare costs based on expected spending for a typical individual or family. For example:
- Bronze plans: the health insurer pays approximately 60 percent of the cost of care, and the individual typically pays 40 percent.
- Silver plans: the insurer pays about 70 percent of the cost of care, and the enrollee can expect to pay about 30 percent.
- Gold plans: the insurer pays about 80 percent of the cost of care, and the enrollee can expect to pay about 20 percent.
- Platinum plans: the insurer pays about90 percent of the cost of care, and the enrolee can expect to pay about 10 percent.
As a general rule, the more comprehensive the coverage, the higher the premium; the lower the premium, the higher the potential out-of-pocket costs.
Age
Insurance companies both on and off the marketplace use age as one factor when determining the premium rate. To illustrate an example scenario, assume a couple isage 50 with a yearly income of $70,000:
- For a couple, the average monthly premium for a Silver plan is $1,333
- For a couple with one child, the average monthly premium for a Silver plan is $1,618
- For a family of five, the average monthly premium for a Silver plan is $2,189
(Source: KFF)
Family health insurance plan types
Marketplace health insurance plans are characterized by four basic plan types. Plan types feature participating healthcare provider networks with benefits designed around plan enrollees’ use of healthcare providers who are participating in the plan’s network (in-network providers).
- Health Maintenance Organization (HMO): HMOs tend to have low premiums but require you to select a Primary Care Physician (PCP) who participates in the network and coordinates your care through referrals to specialists in the network for covered services, except in emergencies. Outside of emergencies, you usually pay the entire bill for services you receive outside the HMO network.
- Exclusive Provider Organization (EPO): EPOs also tend to have low premiums. In an EPO plan, you still need to use the health plan’s in-network providers and select a participating PCP to get benefits from your plan, but you usually don’t have to get PCP referrals to see in-network specialists.
- Point of Service (POS):POS plans are more flexible –and typically more costly—than HMOs and EPOs. Usually you select a PCP from the plan’s network but you aren’t required to get referrals for specialized care and you can go outside the plan’s network and receive benefits for covered services. You pay more for out-of-network care, but your insurer pays a portion of the eligible expenses.
- Preferred Provider Organization (PPO): PPOs tend to be the most expensive plan type because they usually offer a broader range of participating providers, don’t require referrals to specialists, and pay a portion of the eligible expenses for covered services provided outside the plan’s network.
Ways to save on family health insurance
If you buy your own health insurance, you may get help paying for it from the government.
TheAdvanced Premium Tax Creditsubsidy lowers monthly premiums for those whose household income is below 400 percent of the Federal Poverty Level (FPL) and choose a Silver plan on the Marketplace. However, the passage of the American Rescue Plan Act of 2021 expanded ACA subsidies, and eliminated the cap on household income. Individuals may be eligible for premium subsidies if the cost of their premiums is more than 8.5% of their income and they don’t have access to other affordable health insurance. The provision continues through 2025 under the Inflation Reduction Act of 2022. When you’re shopping for plans on eHealth’s website, you’ll be able to see if you are eligible for the tax credit subsidy or other cost-sharing savings.
You could choose a High Deductible plan that pairs with a health savings account. Health savings accounts, or HSAs, are accounts that you use to pay for medical expenses. You save on taxes with a health savings account because the money you put in and take out is either tax-free or tax-deductible. You can also save on your monthly premium because High Deductible health insurance plans paired with HSAs are inexpensive.
TheChildren’s Health Insurance Program, or CHIP, is a joint Federal-state effort to provide free or inexpensive insurance to families with children. The specific requirements for this program vary from state to state, but, in general, your family will qualify if you make too much money to qualify for Medicaid but your income is below 200% of the federal poverty line.
One alternative to traditional health insurance plans for families isshort term health insurance. Short term plans usually do not have the same level of coverage as major medical plans, and insurance companies can deny short-term coverage based on pre-existing conditions. Although you won’t be receiving the same benefits with short term coverage, you will likely be paying a lot less in premium. If affordability is an issue, and you needtemporary coverage, short term health insurance might be an option for you. Keep in mind that not all states offer options in short-term plans.
