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Find Health Insurance Plans and Prices on the Marketplace Exchange – healthcare.gov Editor's Pick

Find individual health insurance plan options and prices at healthcare.gov. This is the ONLY health insurance site to use if you want (and qualify for) the federal subsidies for affordable health insurance AND your state participates in the federal marketplace exchange. Compare plans on monthly premium prices, deductibles, plan features and star quality ratings. The federal marketplace exchange shows Bronze, Silver, Gold and Platinum metal levels. It first opened for 2014. People who don’t get subsidies can also choose a plan and enroll at healthcare.gov. Open enrollment for everybody (except Medicare) between November 1 and December 15, 2019 for 2020. Select Preview Now if you just want to scan the plans before you create an account. At minimum, enter your age, or you may get false prices. If you lose coverage during the year, you may also qualify to enroll outside of the Nov.-Dec. open enrollment. Links are provided to your state marketplace if your state has its own health insurance website. Editor’s Pick.

Average 2018 Health Insurance Plan Premium for Single Coverage (MEPS)

The average total single premium for each private sector employee enrolled in a health insurance plan was $6,715 in 2018. Table I.C.1 shows average premium by size of company, industry, for-profit vs nonprofit, union establishments vs nonunion, and other breakouts.  Report on private-sector establishments, from the Medical Expenditure Panel Survey (MEPS) summary tables.

Average 2018 Premium on the Health Insurance Exchange (Feb. 2019)

On average, individual premiums were under $600 per month for a plan on last year’s health insurance exchanges, as of February 2019. Across all states, the average premium was $594 for the plans selected by individuals. About 87% of people received the Advance Premium Tax Credit (APTC) (which is based on income) to bring the net cost to individuals, down to about $80 per month.  The difference (about $514 per month) is covered by the government (“Obamacare”). Average cost varied by state, with 8 states (IN, MA, MI, MN, ND, NM, RI, UT) and DC having average monthly premiums under $500, before factoring in the APTC. The best average net costs to individuals receiving the APTC were in OK ($18), NE ($25), IA ($31), UT ($34), MS ($37), and ID ($44 per month). Highest average premium states were Wyoming at $943 ($48 with premium tax credit), West Virginia at $928 ($166 with premium tax credit) and Iowa at $913 per month. The national average premium of $594.17 per month works out to $7,130 premium cost per year. Source report from CMS, August 12, 2019, Early 2019 Effectuated Enrollment Snapshot.

Average Deductible & Co-Pay in Health Insurance: MEPS, 2017

The MEPS Insurance Component 2017 Chartbook reports that 87.5% of employees had health insurance plans with an annual deductible.  Average deductible was $1808, but in medium size firms (50-99 employees) deductibles averaged $2361 (single). Family average deductible in US was $3396 in 2017.  For small companies, the average deductible was $2136 single and $4447 family. Average co-pay for an office visit was $26.50. Large report (185 pages) and many charts showing trends since 2004. See Section 5 for employee cost-sharing. Data from the 2017 Medical Expenditure Panel Survey, Chartbook #22, pub. October 2018.

Average Health Insurance Cost, MEPS 2017, by State (pdf)

The Commonwealth Fund shows average Single and Family health insurance premiums for US (employer coverage, $6,368 single, $18,687 family) using MEPS data for 2017. Family rates were lowest in Utah ($16,350); highest in Alaska ($22,417). Utah also had the lowest Single premium rates ($5,568), followed by Arkansas. Employee contribution to health insurance premiums as a percent of median household income ranged from 4.8% in Michigan to 10.2% in Louisiana, averaging 6.9% for the US. With the deductible, if fully used in a given year, the combined premium and deductible in Louisiana could reach 15.5% of median household income. Single deductible averaged $1,808. Hawaii had the lowest single person deductibles in 2017, averaging $863.  Average deductible for a single plan topped $2,300 in both Maine and New Hampshire.  MEPS is the Medical Expenditure Panel Survey. See full Data Brief for specifics in each state. “The Cost of Employer Insurance Is a Growing Burden for Middle-Income Families”, published by The Commonwealth Fund, December 2018.

Average Total Premiums and Employee Contribution, Selected Cities, 2018 Editor's Pick

The 2018 average health insurance premiums and amount of employee contribution for single, single-plus-one, and family coverage by selected cities and metropolitan regions, or remainder of state shown in this MEPS table of costs for private-sector businesses. Average single premiums in many parts of the country continue to exceed $7,000 or even $8,000 (Alaska and the Tampa, St. Petersburg, Clearwater Florida metro area). Lowest single rate $5,519 was in Memphis, TN. Average employee-plus-one premiums were over $11,000 across the US; exceptions were Las Vegas area and Memphis, where premiums for employee-plus-one cost $10,900. Alaska’s employee-plus-one rate topped $16,000 in Anchorage. Family premiums were best in Des Moines, Iowa at $16,257 and Albuquerque New Mexico ($16,788); but topped $23,000 in the New York metro area and parts of New Jersey. Average Single contribution was under $2000 across the US, except in the parts of Massachusetts outside of the Boston-Cambridge metro area. Coverage levels and plan design will vary.  Data from MEPS, the Medical Expenditure Panel Survey, Insurance Component.

Cost-Shifting adds $1788 to health insurance cost for family of four (Milliman study)

Study by Milliman shows that cost-shifting from Medicare and Medicaid underpayments added $1788 to a family health insurance cost in 2006-2007. This amounts to about 15% of the amount paid for hospital and physician costs for privately insured people. Premiums paid through employer-provided insurance were estimated to be 10.6% higher due to the cost-shifting. Study uses 2006 and 2007 data. With medical inflation, the cost shift would be more than $2500 in today’s dollars. Study was commissioned by the AHA (American Hospital Association), AHIP and Blue Cross Blue Shield Assn/Premera Blue Cross, released December 2008.

Federal Exchange Marketplace Average Rate Changes for 2020 (CMS)

CMS reported average rate changes in health insurance premiums on the federal exchange marketplace for two types of sample consumers – a 27 year old, and a family of four. Both the 27 year old and family of four premiums for the second-lowest cost silver plan are reported to be reduced by 4%, on average, for the upcoming 2020 enrollment. The exchange opens on November 1, 2019. No information about average price hikes or reductions were presented for older consumers. Also not disclosed in the CMS press release, Oct. 22, 2019, is the increase in the size of deductibles. The Advisory Board reports that median deductible for mid-level silver plans on the federal exchange will increase by 3%, rising to $4,604 for 2020.

According to CMS, the silver plan premium for a 27 year old is expected to average $406 per month in 2020. (For reference, the average premium paid by enrollees last year was $594.17, since the average enrollee is older than 27 years of age. AARP noted that a 2019 Kaiser Family Foundation report found that a 60-year-old not eligible for subsidies paid $708 a month for the lowest-cost bronze plan and $943 a month for the lowest-cost silver plan.) Costs for older consumers in 2020 were not readily available.

Find Health Insurance Plans and Prices on State-Based Marketplace Exchanges Editor's Pick

Find health insurance plans and prices in states that use the state-based marketplace exchanges, instead of the federal healthcare.gov marketplace. Here are the links for 12 states and DC. The federal subsidies still apply to these state exchanges: CA, CO, CT, Washington DC, ID, MD, MA, MN, NV, NY, RI, VT and Washington state.  The states will show Bronze, Silver, Gold and Platinum metal levels. Compare plans on monthly premium prices, deductibles, plan features and quality ratings. Open enrollment for everybody (except Medicare) between November 1 and December 15, 2019 for 2020. You may have to create an account before you can see the plan options. But each state will vary. If you lose coverage during the year, you may also qualify to enroll outside of the Nov.-Dec. open enrollment.

Health Insurance Cost Estimate, 2018 Survey (Mercer)

Mercer’s annual National Survey of Employer-Sponsored Health Plans, found that the total health benefit cost increased 3.6% in 2018, to an average of $12,666 per employee. (Average of $12,148 for small employers, to $13,018 for large employers.) A majority of large firms offered HSA High Deductible health plans (CDHP) in 2018; overall about 33% of employees are on such plans. Average deductible for a PPO plan in a mid to large company approached $1000. For small companies (10 to 499 employees), average deductible was $2023. Highlights of the survey released November 2018.

Health Insurance Premiums – 2019 Employer Health Benefits Survey – KFF Editor's Pick

Annual survey reports that premiums for employer-sponsored health insurance coverage rose 5% for families and 4% for singles in 2019. Average single coverage cost $7,188 per year ($1,242 paid by workers), and family coverage averaged $20,576 per year ($6,015 paid by employees). High deductible health plans (with savings option) have about 30% share of covered workers, but overall, 82% of workers had a high deductible. For small firms, the average single deductible is $2,271, although firms may make a contribution toward that cost. Survey of 2, 012 nonfederal public and private companies with 3 or more employees completed Jan. to July, 2019. Findings released Sept. 2019 by the Kaiser Family Foundation (KFF) and National Research, LLC. Very detailed report

Individual Employee Annual Health Insurance Premium Cost – 2018

MEPS data reports average health insurance premium cost of $6,715 per year (about $560 per month) from 2018 for a single person’s policy. Costs are for employee enrollees. Only three states managed to come in, just barely, under $6,000 for a year for one person: TN, AR and MS.  Employee contributions were the lowest in Hawaii at about $63 per month, and in Washington state, at about $80 per month. Employer contributions picked up the rest of the cost. Employees paid on average $159 per month in Massachusetts, the highest contribution. Average single employee contribution in US was about $119 per mo. ($1,427 per year) or 21% of the total premium; employers paid 79% of single coverage premiums on average. Compare how much a month health insurance costs in each state. Benefit coverage varies by state and policy. Kaiser Family Foundation (KFF) prepared the tables using MEPS data (Medical Expenditure Panel Study).

Average Health Insurance Cost, Group Market: MEPS private vs public sector

The Medical Expenditure Panel Survey (MEPS) identifies the nationwide 2014 average premium cost for private sector job-related health insurance at $5832 for singles and $16,655 for family coverage. While government employees had plans with higher premiums, the employee contributions were much smaller than amounts paid by private sector employees. Statistical Brief #486 by AHRQ, March 2016. The report has not been updated by MEPS.

Average Health Insurance Cost, Individual Market: MEPS 2014 (pdf)

Average health insurance premium for someone who bought a policy privately (non-group individuals) in 2014 was $3137 (single policy) and $6904 for a family policy.  The median premium cost was $2317 for a single, and $5287 for a family.  Data source: Medical Expenditure Panel Survey (MEPS); 2014 was the first year of the health insurance exchange. MEPS has not updated the table.

Other Helpful Listings

Fact Sheet: Underpayment by Medicare & Medicaid (2019)

Analysis by the American Hospital Association shows that Medicare and Medicaid under-pay the true cost of hospital care by about $77 billion. This cost ends up being borne by other payors and commercial insurance. Using 2017 data, it is estimated Medicare pays 87 cents on the dollar, and Medicaid also pays 87. January 2019 report

HSAs and HDHPs now enroll 21.8 million people – Jan. 2017 (AHIP)

An 8% growth in the number of people enrolled in Health Savings Accounts / High Deductible Health Plans brings the number to over 21.8 million Americans, according to America’s Health Insurance Plans, an association representing health insurance companies. Twenty two states have at least 200,000 people enrolled in these types of plans in their states (down from 24 states). California, Illinois, Minnesota, Ohio and Texas have over 1 million each. Average premiums shown, but not out of pocket costs. Minimum deductible is $1300 single for 2017, with $6550 maximum out of pocket costs. Double the numbers for family coverage. Enrollments by large employers have shrunk from their high of 15.3M in Jan. 2015, to 12.9M in Jan. 2017. Large groups still represent a majority (at least 59%) of HSA high deductible plan enrollments. Report released April 2018

Medicare Part B Premiums and Part A Deductibles for 2020

CMS announced the standard Medicare Part B monthly premium will be $144.60 (up $9.10) in 2020 for most recipients ($1,735 per year), with a $198 deductible (up $13). Both the premiums and deductible are up about 7%. High income seniors will pay between $202.40 and $491.60 per month. CMS says about 7% of Medicare beneficiaries pay the high-income premiums for Part B. Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and other items. The Medicare Part A hospital insurance deductible will rise $44 (about 3%) to $1,408. Released Nov. 8, 2019.

WI Group Health Insurance Rates for Small Employers Jan. 1, 2019

The Wisconsin Office of the Commissioner of Insurance (OCI) published the 2019 health insurance company premium rates for small employers (2 to 50 employees) for group health insurance policies. Companies were asked to quote rates for a sample Silver Plan (80/20 with a $3,000 deductible), effective January 1, 2019. Premiums varied by company and city. Examples shown apply to 50 year olds, 35 and 37-year olds. Aetna’s silver plan for a 50 year old non-smoker required a $6,000 individual deductible with a premium cost of $917/month in Superior, WI, and $1,091 in Milwaukee. Anthem Blue Cross PPO ($3,000 deductible) ranged from $702/month (Green Bay) to $1,076 (Prairie du Chien). Similar WPS PPO premiums were $705 (Green Bay) to $1,088 (Madison). Dean, Group Health, CompCare, Aspirus, Security, Humana, HealthPartners, Medica, United Healthcare, Unity and others are listed.

Wisconsin Health Insurance Cost Rankings 2018

Annual premiums and deductibles (2018) for employee health insurance in various metro markets averaged $10,043 per year for single coverage. Citizen Action of Wisconsin, a coalition of individuals and organizations (such as AFSCME locals, AFL-CIO, WEAC, WI Farmers Union), reports health insurance cost in 18 metro regions, including Twin Cities. Rates in Eau Claire ($10,908 per yr, single) were 20% higher than Madison rates ($9,096 per yr.) Most areas exceeded $10,000 single. Health plan costs shown for Twin Cities, Oshkosh, Green Bay, Appleton, Manitowoc, Sheboygan, Fond du Lac, Janesville/Beloit, Wausau, Stevens Point, La Crosse, Superior, Eau Claire, Kenosha, Racine, Milwaukee, Dubuque, more. Uniform benefits package was used for all areas, however the report does not specify what type of benefits and deductibles were included. The report also does not indicate whether the rates were adjusted for regional differences in age, or healthy behaviors. Shows annual inflation pre-ACA (2000 to 2013) compared to after ACA (2014-2018), with post-ACA so very much lower. However, this summary can be misleading. In 2018, large group rates went down 5%, while individual inflation was up 51% (up 60% in Madison, doubled in Green Bay), and small group inflation was 10% compared to 2017. Large Group information reflects government employee rate paid by State of Wisconsin’s Group Health Insurance Program (GHIP). Published December 2017.

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