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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, 2020 for 2021. 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 2019 Health Insurance Plan Premium for Single Coverage (MEPS)

The average single coverage premium for each private sector employee enrolled in a health insurance plan was $6,972 in 2019. This was up 3.8% from the prior year MEPS data. Table I.C.1 shows average premium by size of company, industry, for-profit vs nonprofit, union establishments vs nonunion, and other breakouts. For companies of less than 10 employees, the average single premium was $7,528 per month. Report on private-sector establishments, from the Medical Expenditure Panel Survey (MEPS) Insurance Component summary tables.

Average 2020 Premium on the Health Insurance Exchange (Feb. 2020)

On average, 2020 individual premiums were under $600 per month for a plan on last year’s health insurance exchanges, as of February 2020. Across all states, the average premium in February was $576 for the plans selected by individuals, compared to about $591 in the prior year. About 86% of people received the Advance Premium Tax Credit (APTC) (which is based on income) to bring the net cost to individuals, down to about $85 per month. The difference (about $492 per month) is covered by the government (“Obamacare”). Average cost varied by state. Nine (9) states (CO, MA, MI, MN, ND, NM, NV, RI, UT) had average monthly premiums under $500, before factoring in the APTC. Highest average premium states were West Virginia at $984 ($170 per month, with premium tax credit), Wyoming at $957 ($42 with premium tax credit) and Iowa at $818 per month ($15 with APTC). The national average premium of $576.16 per month works out to $6,914 premium cost per year. Source report from CMS, July 23, 2020, Early 2020 Effectuated Enrollment Snapshot.

Average Deductible and Co-Pay in Health Insurance: MEPS, 2019

Find the average health insurance deductible and co-pay in the MEPS Insurance Component 2019 Chartbook. The report shows that about 87% of employees had health insurance plans with an annual deductible. Average individual deductible was $1,931, but in small (under 50 employees) and medium size firms (50-99 employees) deductibles averaged about $2,400 (single). Family average deductible in US was up 8% to $3,655 in 2019. However, for the smallest companies, the average family deductible was $5,067. Average copayment for an office visit was $26.68. Average deductible and copays are also shown by state. Hawaii, for example, is unusual in that only 38% of employees are in a plan with a deductible. Large report and many charts showing trends since 2006. See Section 5 for employee cost-sharing, and scroll to the charts for a quick view. Data from the 2019 Medical Expenditure Panel Survey, Chartbook #24, published October 2020.

Average Health Insurance Cost, MEPS 2019, by State (KFF)

Find the average health insurance cost for each state in 2019. The Kaiser Family Foundation (KFF) shows average Single,  Family and Employee Plus One health insurance premiums and deductibles using MEPS data for 2019. For US employer coverage, the average Single premium cost was $6,972 ($581 per month), and the average Family premium cost was $20,486. Average Family premiums topped $20,000 for the first time. Arkansas had the lowest Single premium rates ($6,054), followed by Mississippi ($6,199). Alaska had the highest average single premium cost at $8,933. Family rates were lowest in Alabama ($17,734); highest in Alaska ($22,969).

Deductibles: Single deductibles averaged $1,931, up 4.6%. Hawaii had the lowest single person deductibles again in 2019, averaging $1,264. Washington DC had an average $1,306 single deductible. These were the only two that had average deductibles under $1,500. The highest average deductible for a single plan topped $2,500 (Montana). Family deductibles averaged $3,655, ranging from $2,619 in Hawaii, to $4,615 in Tennessee.

Amounts paid by Employers: On average, employers paid 79% of the single premium cost, and paid 72% of the family premium. Employees paid the difference: 21% of single premium cost and 28% of the family monthly premium. See specifics in each state. MEPS is the Medical Expenditure Panel Survey. Updated September 2020.

Average Total Premiums and Employee Contribution, Selected Cities, 2019 Editor's Pick

The 2019 average health insurance premiums and amounts of employee contribution are shown for selected cities and metropolitan regions. MEPS table IX.A.2 shows annual premium costs for single, single-plus-one, and family coverage for private-sector businesses. Only 3 areas had average single premiums under $6,000 per year. Average single premiums in many parts of the country continue to exceed $8,000. Anchorage Alaska had an average single premium of $9,530. Lowest single rate $5,605 was in San Antonio-New Braunfels, Texas. Average employee-plus-one premiums were over $11,000 across the US; just one exception was the San Antonio area, where premiums for employee-plus-one cost $10,894. The New Haven-Milford, Connecticut employee-plus-one rate topped $17,000. Family premiums were best in Virginia Beach-Norfolk-Newport News, VA and Fargo, North Dakota at just over $17,000 per year. Family premiums were highest in parts of New Jersey, nearing $25,000. Average Single contribution was under $2000 across the US. Coverage levels and plan design will vary. Data from MEPS, the Medical Expenditure Panel Survey, Insurance Component.

Cost-Shifting adds $1,788 to health insurance cost for family of four (Milliman study)

Study by Milliman shows that cost-shifting from Medicare and Medicaid underpayments added $1,788 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. With medical inflation, the cost shift would be more than $2,600 in today’s dollars, or more than $200 on the monthly premium. 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 2021 (CMS)

CMS reported average rate changes in health insurance premiums for 2021 on the federal exchange marketplace for two types of sample consumers – a 27 year old, and a family of four. The premium cost for the second-lowest cost silver plan is reported to be reduced by 2%, on average, for the 2021 enrollment currently underway. The healthcare.gov exchange opened on November 1, 2020. No information about average price hikes or reductions were presented for older consumers. Also not disclosed in the CMS press release, Oct. 19, 2020, is the increase in the size of deductibles.

According to CMS, the average silver plan premium for a 27 year old is expected to be $389 per month in 2020 and $379 in 2021. Older enrollees pay more, but costs for older consumers in 2021 were not disclosed in the press release. (For reference, the average premium paid by all enrollees in 2018 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.) Open enrollment closes December 15, 2020.

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 14 states and DC. The federal subsidies still apply to these state exchanges: CA, CO, CT, Washington DC, ID, MD, MA, MN, NV, NJ, NY, PA, 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, 2020 for 2021. 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, 2019 Survey (Mercer)

Mercer’s annual National Survey of Employer-Sponsored Health Plans, found that the total health insurance benefit cost increased 3.0% in 2019, to an average of $13,046 per employee. (Average of $12,374 for small employers, to $13,455 for large employers.) A majority of large firms offered HSA High Deductible health plans (CDHP) in 2019; overall about 36% 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 jumped to $2,285. Highlights of the survey released October 2019.

Health Insurance MEPS 2019-2020

Health Insurance MEPS Chartbook #24  analyzes health insurance in 2019. Average total premium in 2019 was $6,972 for single; $13,989 for single plus one; and $20,486 for family coverage. Employees contributed 21.4% on average toward the single premium. Employee contributions rose to 28% for family coverage, with employers covering the rest of the cost. Average single deductible was $1,931, more than double the 2009 deductible. Chartbook examines employer offer rates and employee participation rates by industry sector. Detailed report shows trends back to 2006 and costs by state, as well as employer size. Medical Expenditure Panel Survey Insurance Component 2019 Chartbook (MEPS data) published October 2020

Health Insurance Premiums – 2020 Employer Health Benefits Survey – KFF Editor's Pick

KFF’s annual Employer Health Benefits survey for 2020 reports that premiums for employer-sponsored health insurance coverage rose 4% for families and 4% for singles. Average single coverage cost $7,470 per year ($1,243 paid by workers), and family coverage averaged $21,342 per year ($5,588 paid by employees). High deductible health plans (with savings option) have about 31% share of covered workers, but overall, 83% of workers had a deductible. The average single deductible was $1,644, down $11 from 2019. More than one in four covered workers had a deductible of at least $2,000. For small firms, the average single deductible was $2,295, although firms may make a contribution toward that cost. Average copays were $26 for a primary care visit, and $42 for a specialist. Survey of 1,765 nonfederal public and private companies with 3 or more employees completed Jan. to July, 2020. Findings released October 2020 by the Kaiser Family Foundation (KFF). Very detailed report

Individual Employee Annual Health Insurance Premium Cost – 2018

Average health insurance premium cost was $6,715 per year (about $560 per month) in 2018 for an individual employee. See table of costs for single person 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).

Medicare Personal Plan Finder (medicare.gov)

The Medicare Personal Plan Finder site at medicare.gov helps you locate supplemental health insurance plans, find out their prices (premiums), and link to a page to check Medicare Eligibility. Generally, one has to be age 65 or disabled to qualify for Medicare. Early retirement at age 62 does NOT by itself allow someone to receive Medicare benefits

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

Compare the average health insurance cost in the private sector group market with the public sector rates. The Medical Expenditure Panel Survey (MEPS) identified the nationwide 2014 average premium cost for private sector job-related health insurance at $5,832 for singles and $16,655 for family coverage. Government employees had plans with higher premiums (18% higher for single coverage.) However, the employee contributions to the premiums were much smaller if they worked for government employers 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 cost for someone who bought a policy privately (non-group individual market) in 2014 was $3,137 (approximately $261 per month for a single policy). According to MEPS, the family policy cost $6,904 a year (approximately $575 per month). The median annual premium cost was $2,317 for a single, and $5,287 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)

HSAs and HDHPs enroll 21.8 million people according to America’s Health Insurance Plans (AHIP), as of Jan. 2017. An 8% growth in the number of people enrolled in Health Savings Accounts (HSAs) / High Deductible Health Plans (HDHPs) brought the number to nearly 22 million Americans, 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 was $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. AHIP is an association representing health insurance companies. Report released April 2018. Separately, research as of June 2019 (not shown) by Devenir Research, indicates that more than 26 million people now have HSAs. The minimum deductible for a HDHP that qualifies for an HSA is $1,400 for 2020.

Medicare Advantage Plans Part C Premium Costs for 2021 (CMS)

CMS announced that the average Medicare Advantage plan (Part C) premium cost will decrease in 2021. There will be about 4,800 such plans for 2021 that are expected to enroll about 42 percent of Medicare beneficiaries. Medicare Advantage plan enrollment has been increasing in recent years as people switch from traditional Medicare. Plans vary widely by state and region. CMS estimates the average monthly rate will be $21 per month (plus what you will pay directly to Medicare for Part B). Medicare Advantage plans may or may not include Part D drug coverage. Read very carefully. For many consumers, there will be a $0 monthly premium. However, in all plans, there will be copays, deductibles, and out of pocket maximums to consider. At the end of the press release are links to actual premiums by name of health plans in each state. Press Release issued September 24, 2020.

Medicare Part B Premiums and Part A Deductibles for 2021

CMS announced the standard Medicare Part B monthly premium will be $148.50 (up $3.90) in 2021 for most recipients ($1,782 per year), with a $203 deductible (up $5). Part B premiums are up about 2.7% and the deductible is up about 2.5%. High income seniors will pay between $207.90 and $504.90 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 $76 (about 5%) to $1,484. Released Nov. 6, 2020.

MLR Rebates on Health Insurance – 2019

How much were the rebates on health insurance, due to the MLR (medical loss ratio)?  Nearly 9 million people received rebates in 2019, for the 2018 health insurance year. That’s because insurers spent less than 80% of premium dollars (or 85% for large group plans) on medical care and quality improvement. When their charges proved to be too high, based on the MLR calculation, insurance companies are required to issue a rebate back to the consumer or company who paid the bill. The average family received $154. There were no rebates in Maine, North Dakota, Oregon, Rhode Island, South Dakota, Vermont, or Wyoming. In Kansas, however, the average rebate topped $1,000. See where family rebates were the highest. Summary published April 2020.

WI Group Health Insurance Rates for Small Employers Jan. 1, 2020

Compare 2020 group health insurance rates for small employers in Wisconsin. The Wisconsin Office of the Commissioner of Insurance (OCI) published the 2020 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 (such as 80/20 with a $3,000 deductible), effective January 1, 2020. Premiums varied by company and city. Examples shown apply to 50 year olds, 35 and 37-year olds. Anthem Blue Cross’ PPO silver plan for a 50 year old non-smoker required a $3,000 individual deductible with a premium cost that ranged from $730/month (Appleton) to $925 in Hudson, to $1,149 (Prairie du Chien). Dean Health Plan HMO silver plan with a $4,800 individual deductible was $399 in Madison (50-year old nonsmoker), but $649/month in Eau Claire.  Similar WPS PPO premiums were $722 (Green Bay) to $1,113 (Madison). United HMO ($2,500 deductible) was $688/month for a nonsmoking 50-year old in Milwaukee; Hudson rates were $666/month, up to $900/month in La Crosse. Group Health, CompCare, Aspirus, Security, Humana, HealthPartners, Medica, Quartz 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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