What Is a Health Insurance Premium?

What’s the very first thing that involves thoughts whenever you hear the phrase premium? Do you consider high-grade gasoline for high-performance vehicles? Or first-class tickets for airline flights? 5-star restaurant meals?

The premium tag will be hooked up to all these issues. However within the medical insurance business, premium has a a lot less complicated that means. Mainly, it simply means your month-to-month invoice.

However as strange as that sounds, rather a lot goes in to figuring out how a lot that month-to-month invoice is. We’ll clarify all these components so you’ll be able to perceive how every one impacts your premium and how one can lower your expenses.

What Is a Well being Insurance coverage Premium?

Put merely, a premium is the month-to-month quantity you pay to maintain your medical insurance plan energetic. The medical insurance business units premium costs by contemplating a number of components.

When procuring in your medical insurance plan, needless to say the plan with the bottom premium may not be the only option in your well being care wants. We’ll clarify why.

Do you have the right health insurance coverage? Connect with a Trusted pro today.

However first, let’s go over the components insurance coverage corporations use to calculate your month-to-month premium quantity.

How Are Well being Insurance coverage Premiums Calculated?

Your medical insurance premium is initially calculated utilizing 5 foremost components: age, location, tobacco use, the variety of individuals in your coverage and the plan class.1


This one’s simple. The older you might be, the upper your premium. Medical health insurance corporations know that as you age, you’ll want extra medical care. And that will increase the danger that they’ll be on the hook for paying larger medical prices in your behalf.


The place you reside has a big effect in your premium quantity as a result of it impacts issues like competitors with different insurance coverage corporations, state and native legal guidelines about protection necessities, and price of residing.

Tobacco Use

Medical health insurance corporations are conscious that tobacco use can have a direct impact on the price of your medical payments. To place it bluntly, tobacco customers are out of luck right here—insurers can cost tobacco customers as much as 50% greater than those that don’t use tobacco.2

Variety of Folks on Your Coverage

The variety of individuals in your medical insurance plan performs a significant position in how a lot you’re charged in your premium. In case your medical insurance plan additionally covers a partner or dependent (along with you), insurers can cost extra in your premium.

Plan Class

The medical insurance business makes use of “metallic” classes to separate several types of well being care plans: bronze, silver, gold, and platinum. (Catastrophic plans are additionally obtainable from some individuals.)

Every class relies on the way you and the plan share medical prices. For instance, platinum plans normally have a better premium and decrease out-of-pocket prices.3 Out-of-pocket prices embrace deductibles, copays and coinsurance (we’ll get to that in a minute).

On the opposite finish of plan classes, catastrophic plans (aka medical insurance for wholesome individuals) sometimes have the very best out-of-pocket prices and the bottom premiums, however they’re solely obtainable to individuals beneath 30 or individuals with revenue or hardship exemptions.4

Listed below are just a few examples to point out how all these variables go into calculating your premium. Assuming all different components are the identical in every state of affairs beneath, listed below are three examples of how premium quantities are calculated:

Instance #1: Let’s say you’re searching for an insurance coverage plan only for your self. You’re 30 years outdated and in good well being. The neatest medical insurance plan for you’ll have excessive out-of-pocket prices and a low premium. That’s since you’re not more likely to go to the physician rather a lot, so that you gained’t have a ton of ongoing medical payments. Use the cash you save on premiums to construct up your financial savings to cowl medical bills once they crop up.

Instance #2: You bought married! Now you’re searching for a medical insurance plan for your self and your partner. You’re each in your early 30s and in good well being. Once more, the neatest plan in your state of affairs can have excessive out-of-pocket prices and a decrease premium. (Your premium might be considerably larger than it was in instance #1 as a result of there are actually two of you on the coverage.)

Instance #3: Now think about you’re searching for a medical insurance plan in your complete quick household (partner and two youngsters). One in all your youngsters (sadly) has cystic fibrosis and requires frequent journeys to the physician, requiring larger out-of-pocket prices. On this case, the plan with the bottom premium may not be the most effective match for you. You’ll need a plan with a better premium and low out-of-pocket prices.

It’s vital for us to notice that these examples are all based mostly on plans you’ll discover within the federal medical insurance market. States that run their very own medical insurance exchanges have their very own pricing pointers.

We suggest connecting with one of our Endorsed Local Providers (ELPs) who can get into the nitty-gritty of premium price pointers for well being protection in your space.

How Do Deductibles Have an effect on Well being Insurance coverage Premiums?

Now is an effective time to speak about medical insurance deductibles, as a result of just like the 5 components we simply talked about, deductibles immediately have an effect on your premium quantity. However in contrast to these 5 components, you get to select your deductible quantity.

To decide on the proper deductible, it’s vital to know the way your deductible impacts your premium. The simplest approach to learn the way they relate to one another is to keep in mind that the upper your deductible, the decrease your premium, and vice versa.

At this level you could be considering, Why would I ever need a low deductible and a better premium. That’s nuts!

Whereas that could be true for wholesome individuals, it doesn’t apply to all people. Keep in mind the cystic fibrosis instance. A continual sickness like that would require month-to-month journeys to the physician, averaging $500–1000 per go to. And that provides up shortly.

However should you go for a low deductible plan with a better premium, you’ll solely must pay for the primary few visits as a result of your insurance coverage firm will begin overlaying a bit of your prices after you meet your low deductible.

You’ll pay a better premium every month, however on the finish of the yr, you’ll have saved cash by reaching your deductible sooner, which implies extra of these workplace visits might be lined by your insurance coverage.

Now let’s discuss in regards to the logistics of constructing your month-to-month premium cost to maintain your plan energetic.

How Do I Pay My Well being Insurance coverage Premium?

You pay your medical insurance premium based mostly on the place you bought your plan.

Should you purchased your plan via the medical insurance market or a personal insurer, you’ll pay your premium on to the insurance coverage firm (both by verify, digital cost or computerized withdrawal).

Be sure you proceed to pay your month-to-month premiums to your medical insurance firm on time. Should you do not, the insurance coverage firm may finish your protection.

Should you purchased your plan via your employer, a portion of your premium is normally paid for by your employer, and the premium steadiness is deducted out of your paycheck—normally pretax, which implies you’re not paying revenue taxes on the portion of your premium you pay.

Except you make different preparations together with your employer’s plan administrator, you gained’t have to recollect to make your premium cost as a result of it is going to be routinely deducted out of your paycheck.

How Can I Save Cash on My Well being Insurance coverage Premium?

Prepared for some excellent news? There are some easy methods it can save you cash in your premium.

Apply for a Tax Credit score

One of many best methods to economize in your medical insurance premium should you’re not getting it via your employer is by utilizing a federal tax credit score that’s based mostly in your revenue estimate. Once you apply for insurance coverage via the federal market, you’ll be requested your (internet) annual revenue quantity. Relying in your reply, you might be eligible for a tax credit score to decrease your premium.5

Select an HMO

One other simple approach to keep away from a excessive premium is to choose an HMO plan instead of a PPO plan. HMO stands for well being upkeep group and PPO stands for most popular supplier group.

Sometimes, HMO plans are cheaper than PPO plans since you’re required to make use of docs who’re a part of the insurance coverage firm’s community of suppliers. The one draw back is that HMO plans will be much less versatile than PPOs.

Select a Excessive Deductible

The way in which deductibles have an effect on your premium is vital sufficient to repeat right here: The upper your plan’s deductible, the decrease your premium.

For 2021 and 2022, the IRS defines high-deductible well being plans (HDHP) as a minimum of $1,400 for people and $2,800 for households.6

Saving cash in your premium is simple right here. All it’s good to do is select a plan with a deductible that’s excessive sufficient to fulfill the IRS’s necessities.

Should you select a high-deductible medical insurance plan, you’ve an important alternative to open a Well being Financial savings Account (HSA) the place it can save you cash (tax-free) for potential medical bills.

Select a Decrease Coinsurance Proportion

Coinsurance percentages supply one other approach to save. Coinsurance is the share of well being care prices you’re accountable for paying after you’ve hit your deductible for the yr.

Once you take a look at your coverage, you’ll see your coinsurance proven as a fraction—one thing like 80/20 or 70/30. The usual coinsurance quantity is 80/20, which implies you’re accountable for 20% of your medical bills, and your medical insurance will deal with the remaining 80% when you’ve met your deductible.

The vital factor to recollect right here is that your coinsurance ratio immediately impacts your premium quantity: The upper your coinsurance proportion, the decrease your premium. So, in case your coinsurance is 60/40, your premium cost might be decrease than it might be in case your coinsurance was 80/20.

Select Greater Copayments

You may as well preserve your premium price low by selecting a plan with a better copayment. Copayments are the fastened quantities you pay on the time of your physician go to. On the whole, plans with larger copayments have decrease premiums than plans with decrease copayments.

Discover the Proper Well being Insurance coverage Premium for You

As a result of there are such a lot of variables that may contribute to medical insurance premium quantities, you want a professional to assist information you thru the maze.

We lined the fundamentals on this article, however to get extra complete recommendation from an professional, we suggest contacting one in every of our Endorsed Native Suppliers (ELPs). We suggest these suppliers as a result of they share the monetary values we train and supply distinctive customer support.

Connect with one of our trusted ELPs today!


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