It is one of the most common questions people type after leaving a job: how much will health insurance cost me now? The honest answer is that it varies a lot, and the quickest way to a useful number is to understand what drives the price. This guide explains the main factors so you know what to expect before you run quotes.
The five things that set your premium
Individual health plans sold through the Marketplace are priced mostly on:
- Your age. Older adults pay more, within limits set by law.
- Where you live. Prices vary by state, county, and which insurers compete there.
- Tobacco use. In most states insurers can charge more for tobacco users.
- Plan tier. Bronze, Silver, Gold, and Platinum plans trade monthly premium against deductibles and copays. See our Bronze vs. Silver vs. Gold guide.
- Household size. Covering a family costs more than covering one person, though children are priced differently.
Notice that your health history is not on the list. ACA-compliant plans cannot charge you more because of pre-existing conditions.
Income matters more than most people expect
Premium tax credits reduce the monthly price of Marketplace plans for many households. How much help you get depends on your expected household income, the cost of a benchmark plan in your area, and the rules in effect for that year. Two households with the same plan can pay very different amounts after subsidies. If your income dropped when you lost your job, you may qualify for more help than you expect, or even for Medicaid in some states.
Your realistic options
- COBRA. You keep your old plan, but you typically pay the full premium plus an administrative fee. It can be expensive, but it may make sense if you are mid-treatment or near your deductible.
- Marketplace plan. Often the best value once subsidies are considered, with multiple tiers to choose from.
- Medicaid. Based on income and state rules.
- A spouse's or partner's employer plan. Losing coverage can open a window to join.
- Short-term plans. Cheaper but with limits and exclusions, so they are not a substitute for comprehensive coverage.
Get real numbers for your household
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Get my free quoteThe costs beyond the premium
The premium is only part of the bill. Compare these too:
- Deductible. What you pay before the plan starts sharing costs. See deductible vs. out-of-pocket maximum.
- Copays and coinsurance. What you pay for visits and services.
- Out-of-pocket maximum. The most you could pay in a year for covered in-network care.
- Drug coverage. Tier structure and pharmacy network.
- Provider network. Whether your doctors are included.
A Bronze plan has a low premium but a high deductible. A Silver plan costs more each month but can include extra cost-sharing help if your income qualifies. A Gold plan costs more still but pays more when you use care.
How to estimate your own price
- Estimate your household income for the year, including any severance or unemployment benefits.
- Count the people who need coverage.
- Note your ZIP code and ages.
- Compare a Bronze, a Silver, and a Gold plan, with subsidies applied.
- Add up the premium, the deductible, and the out-of-pocket maximum for each.
The cheapest premium is rarely the cheapest year. If you expect to use care, a mid-tier plan can cost less overall.
When you can enroll
If you lost coverage, you generally have a Special Enrollment Period of 60 days. If you did not, you usually enroll during Open Enrollment. Read about the 60-day window and how to choose between your options.
Common mistakes
- Picking the lowest premium without checking the deductible.
- Overestimating income and missing out on subsidies, or underestimating it and owing money later.
- Missing the enrollment deadline.
- Not checking whether doctors and drugs are covered.
An example of how subsidies change the picture
Consider two households that both buy the same Silver plan with the same list price. One has a modest household income and qualifies for a substantial premium tax credit, so its monthly bill is small. The other has a higher income and receives little or no credit, so it pays much closer to the list price. The plans are identical, but the real cost is not, which is why a quote without your income and household details is only a rough guess.
What to do first
Make a short list: your expected household income, who needs coverage, your doctors, and your medications. With those four items, a licensed agent can produce a realistic comparison in minutes, including whether COBRA, a Marketplace plan, or Medicaid is likely to fit your budget best.
How we help
Honorbrook is an independent agency. We compare plans and subsidies at your address, explain the trade-offs, and help you enroll. Our help is free, because carriers pay us and your premium is the same either way.
Availability and rules vary by state
Health plans, premiums, enrollment rules and state programs differ by state and sometimes by county, and a given plan may not be available in every state. Honorbrook is licensed in the 11 states below; what we can offer you depends on what carriers sell where you live. Each state’s insurance regulator can verify an agent’s license and answer consumer questions.
- Virginia: Virginia Bureau of Insurance
- Maryland: Maryland Insurance Administration
- North Carolina: North Carolina Department of Insurance
- South Carolina: South Carolina Department of Insurance
- Georgia: Georgia Office of Insurance and Safety Fire Commissioner
- Alabama: Alabama Department of Insurance
- Louisiana: Louisiana Department of Insurance
- Texas: Texas Department of Insurance
- Michigan: Michigan Department of Insurance and Financial Services
- Indiana: Indiana Department of Insurance
- West Virginia: West Virginia Offices of the Insurance Commissioner