What Does Basic Health Insurance Cost?

Basic health insurance costs can be confusing, especially if you are shopping for coverage for the first time or changing plans. The price you pay depends on factors like your age, income, where you live, and the type of plan you choose.

There is no one-size-fits-all answer when it comes to basic health insurance costs because everyone’s needs and circumstances are a little different.

Still, there are some basic guidelines you can follow to get an idea of what health insurance may cost and make a more informed decision.

5 personal factors of basic health insurance costs

The cost of individual health insurance varies, but a few key factors influence how much you’ll pay. They include:¹

1. Your age

Premiums can be up to 3 times higher for older adults than for younger ones.

2. Your income

If you’re shopping for health insurance on the Affordable Care Act (ACA) Health Insurance Marketplace and your income falls below a certain level, you may qualify for extra savings known as cost-sharing reductions (CSRs).

With a CSR, you’ll pay less out of pocket each time you get medical services. You’ll also have:

• A lower deductible (what you pay before your health insurance kicks in)
• Lower copayments (the flat fee you pay for a covered service) or coinsurance (the percentage you pay for a covered service), and a…
• Lower out-of-pocket maximum

However, you must choose a silver ACA plan to get these benefits. Silver plans are the most popular, and they tend to have moderate monthly premiums and costs when you need care. (ACA Marketplace plans are categorized by metal levels: bronze, silver, gold, and platinum.)

3. Where you live

Location matters when it comes to health insurance. Costs vary by state, depending on everything from competition among healthcare companies to state regulations and how much it costs to live there.

4. Number of people in your household

It makes sense that the more people you have on your health plan, the more you’ll pay for it.

But depending on your income level and household size, you may be eligible for a premium tax credit, which can lower the monthly premiums for an ACA plan.²

Unlike cost-sharing reductions, a premium tax credit can be used with any metal level plan.

5. Tobacco use

Insurance companies can charge tobacco users up to 50% more than those who don’t use tobacco.

4 levels of coverage that affect health insurance costs

There’s not much you can do to change the factors that raise your premiums. But one thing you can do is determine which metal plan in the ACA Marketplace works best for you.

Each metal level represents how you and your insurance company will share insurance costs. Keep in mind, all of these plans cover preventive services at no additional cost to you.

Here’s a quick look at your options:³

1. Bronze

• Insurance company pays: 60% of total yearly costs of your care
• You pay: 40%

A lower-costing bronze plan is a way to protect yourself in emergencies, and may be a good choice if you are in very good health and see the doctor infrequently.

Your monthly premium may be low, but you may have to pay a lot before meeting your deductible.

2. Silver

• Insurance company pays: 70% of total yearly costs of your care
• You pay: 30%

If you qualify for cost-sharing reductions, this could be the best plan to choose. It could save money each year, especially if you use a lot of care.

You’ll most likely pay a higher monthly premium than a bronze plan, but you’ll pay a lower percentage of the out-of-pocket costs when receiving care.

3. Gold

• Insurance company pays: 80% of total yearly costs of your care
• You pay: 20%

Gold plans usually have a high monthly premium, but if you expect to need a lot of care throughout the year, it may still end up being the best value.

4. Platinum

• Insurance company pays: 90% of total yearly costs of your care
• You pay: 10%

Platinum plans will most likely have the highest monthly premium but the lowest deductible.

In other words, you’ll pay more per month for your insurance, but it means your insurance will start paying for your out-of-pocket costs sooner when receiving your care.

Prescription medications

Does prescription medication affect basic health insurance costs?

Yes. Before you choose a plan, look at what prescription medications you take, and compare plans based on prescription drug coverage.

• If you use brand name drugs instead of generics, you might want to choose a higher-tier plan that helps cover those prescriptions.

Catastrophic insurance

You may be eligible for what’s known as a catastrophic plan.⁴ These plans have very low monthly premiums but high deductibles.

In 2025, the deductible for catastrophic plans is $9,200.^5,6

• After you meet that deductible, your insurance company will pay for all covered services.
• For catastrophic plans, preventive care and at least three primary care visits each year are covered at no cost, even before you meet the deductible.

Catastrophic insurance was limited to people under 30 or those with a hardship exemption. However, recent changes by the U.S. Department of Health and Human Services makes catastrophic insurance available to anyone who doesn’t qualify for premium tax credits or cost-sharing reductions.⁷

What type of plan should I buy?

Deciding what type of insurance plan you need to buy can get confusing, so here’s a quick guide:

Exclusive Provider Organization (EPO): Services are covered only if you use doctors, specialists, or hospitals in the plan’s network, except in an emergency.

Health Maintenance Organization (HMO): Coverage is limited to doctors who work for or contract with the HMO. Generally, there’s no coverage for out-of-network care except in an emergency.

Point of Service (POS): You pay less if you use doctors, hospitals, and other healthcare providers that belong to the plan’s network. You need a referral from your primary care doctor to see a specialist.

Preferred Provider Organization (PPO): You pay less if you use providers in the plan’s network, but you can go out of network without a referral for an additional cost.

Which type of plan you choose will depend on where you live and what your healthcare needs are.

If you have pre-existing conditions and anticipate a lot of medical care, a plan with a larger network might work best, even if premiums are higher.

Find basic health insurance with a little help

If you’re still trying to figure out your basic health insurance costs, we can help. Just give us a call at (800) 827-9990 to speak with a licensed health insurance agent or find one in your area.

We’ll review your needs, analyze your coverage options, and show you available plans.