Key Takeaways:  

• Individual health insurance costs vary based on factors like age and location, with older people and those in expensive areas paying higher premiums. 

• Plan types, such as HMO, PPO, and POS, impact premiums and care costs, with more flexible plans typically being pricier. 

• Metal-tier plans (Bronze, Silver, Gold, Platinum) adjust premiums and out-of-pocket costs to offer coverage options that fit different healthcare needs. 

How Much Does Individual Health Insurance Cost? 

In 2023, the average monthly cost of health insurance for a single person in group plans was around $703, according to KFF, and costs are expected to rise by 8.9% in 2024. The premium you pay depends on factors like plan type, age, and location. 

For individual health insurance, costs vary based on coverage level. The 2024 average benchmark premium is $477, with ACA marketplace plans showing varying deductibles and monthly premiums. 

• Bronze Plans: $364 monthly premium with a $7,258 deductible. 

• Silver Plans: $468 monthly premium with a $5,241 deductible. 

• Gold Plans: $488 monthly premium with a $1,430 deductible. 

• Platinum Plans: Higher monthly premiums, but the lowest deductibles. 

Subsidies based on income are available and can substantially lower these costs for those who qualify, making health insurance more affordable by directly reducing the monthly premiums. 

Factors That Influence Health Insurance Costs 

Health insurance costs are influenced by several factors. Below is a breakdown of how each factor impacts costs: 

• Age: Health insurance premiums increase with age due to higher health risks. The Affordable Care Act allows insurers to charge older adults up to three times more than younger individuals to reflect these higher medical costs. 

• Location: Where you live affects your premium—areas like New York or California with higher healthcare costs typically have more expensive insurance. 

• Income: Your income impacts eligibility for subsidies on ACA Marketplace plans, with lower incomes qualifying for reduced premiums and out-of-pocket costs. 

• Plan Type: Plan types like HMOs, PPOs, and HDHPs offer different coverage and flexibility. PPOs allow more provider choice but have higher premiums, while HMOs and HDHPs are typically cheaper. 

• Metal Tier: ACA plans are divided into four metal tiers: Bronze, Silver, Gold, and Platinum.  

Types of ACA Plans 

ACA (Affordable Care Act) plans are health insurance plans offered through the Health Insurance Marketplace. They are divided into four tiers: Bronze, Silver, Gold, and Platinum. Each tier represents a different balance between the cost of monthly premiums and the cost of care. 

• Bronze Plans have the lowest premiums but the highest out-of-pocket costs, making them a good option if you rarely need medical care. 

• Silver Plans offer a balance between premiums and out-of-pocket expenses, and subsidies often apply, making them ideal for moderate healthcare needs. 

• Gold Plans come with higher premiums but lower costs when receiving care, making them suitable for those who need frequent doctor visits or prescriptions. 

• Platinum Plans have the highest premiums but the lowest out-of-pocket costs, ideal for individuals requiring extensive medical care. 

Consider how often you visit the doctor, your medications, and any ongoing health conditions. This will help you choose the tier that best balances monthly costs and coverage for your needs. 

Individual vs. Group Health Insurance 

Individual health insurance is a plan bought by an individual or family, offering customized coverage options to meet specific needs. 

Group health insurance is provided by employers or organizations, spreading risk and cost across more people, which usually results in lower premiums and broader coverage. 

Employer-sponsored health insurance usually has lower premiums than individual plans. According to KFF’s 2023 survey: 

• Annual Premiums: Family coverage averages $23,968, with employees contributing $6,575. 

• Deductibles: The average deductible for single coverage is $1,735. 

• Employee Contributions: Workers at smaller firms pay $2,445 more for family coverage than those at larger firms. 

Employer-sponsored health insurance costs vary by company size, plan type, and coverage. Larger companies often offer lower premiums, while plan types like HMOs and PPOs affect costs; lower premiums usually result in higher deductibles and out-of-pocket expenses. 

How to Calculate and Compare Health Insurance Costs 

When comparing health insurance plans, it’s important to understand the key costs involved. 

• Premiums: These are the fixed monthly payments for your health insurance. Plans with lower premiums often have higher deductibles, while higher premium plans usually come with lower deductibles. 

• Deductibles: This is the out-of-pocket amount you must pay for healthcare services before your insurance kicks in. Higher deductible plans typically have lower premiums, but you’ll pay more upfront until the deductible is met. 

• Copayments: A fixed fee you pay for services after meeting your deductible. For example, if your copay is $30 for a doctor’s visit that costs $150, you’ll pay: 
  • $150 if your deductible hasn’t been met. 
  • $30 if your deductible is met. 

• Coinsurance: The percentage of costs you share with your insurer after reaching your deductible. For example, with 20% coinsurance on a $150 visit: 
  • You pay the full $150 if your deductible hasn’t been met. 
  • You pay $30 (20% of $150) if your deductible is met. 

Both copayments and coinsurance help manage the cost of healthcare by splitting the expense between you and your insurance provider after your deductible is met. 

Out-of-Pocket Costs 

Out-of-pocket costs include deductibles, copays, and coinsurance until you reach your plan’s maximum. In 2024, Marketplace plans have a maximum of $9,450 for individuals and $18,900 for families. After reaching this limit, insurance covers 100% of healthcare costs for the rest of the year. 

Health Plan Types 

Health insurance plans come in various types, including HMO, PPO, EPO, POS, and HDHP. Each offers different levels of flexibility, cost-sharing, and provider networks, helping individuals find coverage that fits their healthcare needs and budget. 

Feature	HMO	PPO	EPO	POS
Benefits of plan	Coordinated care through a PCP; structured network to keep costs low.	Flexibility to see preferred doctors and specialists without referrals; broader provider choice.	No need for referrals to see specialists; direct access to healthcare providers.	Flexibility to use out-of-network providers; requires referrals for specialists.
Cost	Low premiums	Higher premiums	Low premiums	Mid-range premiums
Referrals required?	Yes. These plans manage and coordinate care through a PCP.	No, allows direct access to specialists without referrals.	No, typically offers a broad network but requires using network providers for coverage.	Yes
Out-of-network coverage?	Emergencies only	Yes	Emergencies only	Only in certain circumstances, but at higher out-of-pocket costs.
Network size	Limited network choice but optimized for cost savings and streamlined care.	Smaller networks compared to HMOs but offer broader access including out-of-network care.	Typically offers a broad network but requires using network providers for coverage.	Broader network choice with the option to go out-of-network at a higher cost.

Affordable Health Insurance Options 

You can’t control when you get sick or injured, but you do have some control over how much you pay.   

Enrollment 

Health insurance is most affordable during the Open Enrollment Period (November–January), when you can apply for or switch ACA plans. You can also qualify for a Special Enrollment Period due to major life changes, such as marriage or the birth of a child. 

Government Subsidies 

You may qualify for the Advanced Premium Tax Credit to reduce premiums or Cost-Sharing Reductions for lower out-of-pocket costs, based on income. These programs require ACA Marketplace enrollment and apply to those with incomes between 100% and 400% of the federal poverty level. 

Medicaid 

Every state offers Medicaid and Children’s Health Insurance Plan (CHIP) health coverage to low-income individuals and families, with eligibility and benefits varying by state. Contact your state’s Department of Insurance or Health Department to check eligibility. 

Medicare 

Medicare is available for those 65 or older, or disabled at any age. In 2024, the standard Medicare Part B premium is $174.70. Part A is typically premium-free for those who have worked and paid Medicare taxes for at least 10 years. 

High Deductible Plan and HSA 

High-deductible health plans feature lower premiums and can be paired with HSAs, allowing you to save pre-tax dollars for medical expenses, and providing tax advantages for both contributions and withdrawals. 

Bringing it all together 

Individual health insurance costs vary by age, location, and plan type. Understanding premiums, deductibles, and subsidies helps you find a plan that balances cost and coverage. For personalized quotes, browse by state, or check our list of health insurance companies if you have a preferred carrier in mind.