A major medical health insurance plan is a type of plan thatmeets all of the minimum essential benefit standards of the Affordable Care Act(ACA or “Obamacare”). It also provides benefits for a broad range of inpatientand outpatient health-care services.
It’s important for you to understand that not all major medical health insurance plans can be purchased with a premium tax credit. However, enrollment in a major medical plan does protect you from tax penalties for being uninsured under Obamacare. Please note that as of the 2019 plan year, you’ll no longer pay a penalty in your federal taxes for going uninsured. However, state law varies, and you may owe a state tax penalty if you can afford the cost of major medical insurance but choose to go without it. Check out this article to see if your state requires health insurance.
How much does major medical health insurance cost?
Many factors will affect the cost of your health coverage,including the type of plan you enroll in, the services you need and how often,and whether you take prescription drugs.
When you’re calculating the cost of major medical insurance, it’s important to look beyond just plan premiums, or the monthly amount you’ll pay for coverage. Oftentimes, major medical plans with low premiums may be offset by other costs, such as higher deductibles or cost sharing, or a higher maximum out-of-pocket limit. eHealth’s plan finder tool lets you look up and compare costs like premiums, deductibles, copayments, and more for a wide selection of individual and family plans.
Based on eHealth’s recentstudy, here are 2020 average costs of major medical insurance plans:
Premiums for major medical plans*
- $456 per month for individual coverage
- $1,152 per month for family coverage
Deductibles for major medical plans*
- $4,364 per year for individual coverage
- $8,439 per year for family coverage
*Data according to the latest research from eHealth’s Price Index, based on eHealth shoppers not utilizing government subsidies who selected plans at eHealth during the 2019 open enrollment period.
What factors influence how much major medical insurance costs?
While major medical health insurance premiums rates can vary, fortunately the Affordable Care Act curbed some of the volatility of premium costs by eliminating factors such as gender and pre-existing health conditions (i.e., your current health status or medical history. Still, several factors will affect the actual cost of your major medical health coverage.
- Age. In most states age is a major contributing factor in determining the premium rate for health insurance. (New York and Vermont are notable state exceptions where age is not a permissible determinant for premium rates.) Generally. the older you are, the higher your premium.
- Location. Where you live affects the price of the premiums. Generally, premiums are lower in densely populated areas where numerous insurance companies are competing for business. Rural areas may be served by only one or two insurers and pay more for major medical health insurance.
- Tobacco use. Tobacco use will affect how much health insurance costs you per month. In fact, health insurance companies can charge smokers as much as 50% more than non-tobacco users in most states.
- Choice of plan. The insurance company and type of plan you choose will also affect your health insurance monthly premium. ACA major medical plans are classified by metal tiers: Bronze, Silver, Gold, Platinum and Catastrophic. Each metal tier carries different premiums based on the percentage of overall healthcare costs they cover.
When you’re calculating the cost of major medical insurance, it’s important to look beyond just plan premiums, or the monthly amount you’ll pay for coverage. Oftentimes, major medical plans with low premiums may be offset by other costs, such as high deductibles or a high maximum out-of-pocket limit. The maximum out-of-pocket limit serves as a safety-net, capping your annual out-of-pocket costs for covered services. If you reach this limit, your major medical health insurance plan typically pays 100% of the costs for covered services for the balance of the year.
How do you enroll in a major medical health insurance plan?
The Open Enrollment Period for major medical health insurance occurs each year, starting November 1st for coverage that begins January 1st the following year. Depending on your situation, you may be eligible for a Special Enrollment Period if you have lost your current health insurance, moved, married, had a baby, or similar life changes. You can enroll online via Healthcare.gov or your state’s marketplace if your state has its own health insurance exchange, through a private health insurance exchange, such as eHealth, or by directly contacting a health insurance company or health insurance broker.
Finding major medical insurance plans
At eHealth, it’s our goal to make finding health coverage as simple and painless as possible. Our plan finder tool makes it easy to browse major medical plans from top insurance companies and compare benefits and costs side by side. Remember, health insurance prices are fixed, so you’ll never pay more at eHealth than you would elsewhere.
To get started finding health coverage that fits your needs, enter your zip code in the tool on this page. If you need assistance, call us during business hours to reach an expert licensed insurance agent, who will be happy to help you.
Finding major medical insurance plans for small businesses
For business owners looking for major medical plans, eHealth is here to partner with you, as well. You’ll need at least one employee to be eligible for small business health coverage, and you must contribute to workers’ premiums.
The good news is that you can shop for small business plans at any time of the year and eHealth’s licensed brokers can help you find the right plan for you and your employees. Check out all the available small business health insurance plans, or contact us today to get guidance on finding the right coverage for your business.
Related Articles
- Qualified Health Plans
- Obamacare 101: How Obamacare Health Insurance Works
- Health Maintenance Organization (HMO) Plans
