What Is A Premium, and How Does It Affect Your Health Insurance Costs?
Written by: Andrew Hall
If you compare plans with the same coverage, the plan with a high premium generally will have lower out-of-pocket expenses.
If you generally visit the doctor for preventive care and don’t require special medical care, a High Deductible Health Plan (HDHP) with a lower premium can be less expensive.
Individuals 65 years of age and older can pay less for premiums through Medicare than on private policies through a healthcare exchange.
A health insurance premium is commonly a cost paid per month to keep your insurance policy active. A premium is calculated by the level of medical risk involved with insuring the beneficiary. If you’re shopping for insurance and have a complex medical history, the premium for a policy to cover your needs may be higher. Your premium is not the only cost with your policy, typically other costs like deductibles, copays, and coinsurance can factor into your premium decision.
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Now that you know about your premium let’s consider how premiums factor into your total cost for coverage. Your premium is not your only cost for health insurance. You pay your premium to keep your coverage active, but you may have to consider deductibles, copays, and coinsurance based on healthcare services.
- Coinsurance is a percentage of your medical costs that spit between you and your insurance company. You typically pay 100% until you reach your deductible and then pay a smaller percentage after reaching the deductible.
- A deductible is the amount of money you have to pay before your insurance company begins to pay a percentage of the costs.
- A copay is a fixed amount that you pay for services.
Health insurance premiums don’t come with a fixed price. Health factors and the risk of needing expensive care play a role in determining the premium. The higher risk, the higher premium. Deductibles balance the potential costs of covering someone. A plan with a low deductible will have a higher premium. A plan with a high deductible will have a lower premium. Choosing the plan with the lowest premium isn’t always the best decision, here’s why:
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If you don’t need expensive health care and use your doctor for preventive care most of the time, you can save money with lower premiums and a high deductible.
If you require unexpected major care, like a hospital visit, you may be responsible for a deductible of $2,500 or more before your insurance company begins to pay a percentage of your costs.
Be honest with yourself about the type of care you anticipate needing during the plan year. A high deductible and low premium aren’t always best, and sometimes paying a little more in monthly premium costs can save a lot down the road. Here are a few tips to consider:
- Ask questions about risk. Not every company is going to factor “health risk” the same. You may have a condition that one company sees as “high risk,” and another may see it as “moderate risk,” which can save you money in your premium.
- Know Your Options. If you’re approaching 65 years of age, consider a Medicare Advantage plan or Original Medicare. [i] Your Medicare premiums may be lower than your current policy.
- Read up on HSAs. A high deductible will lower your monthly premium. Saving money in an HSA with your HDHP can add up in the long run and be a valuable resource for unexpected costs toward your deductible. Also, your account earns interest and is portable.
If you know that you need expensive care and can’t afford to purchase or keep the coverage you need, there are options available to assist with your costs. You can contact a GoHealth licensed insurance agent and discuss your options for free. Navigating plan options can be complex, but a licensed insurance expert may help you find ways to save and feel great about the coverage you can secure.
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