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Home » Health, Health Insurance

Healthcare.gov Prices are in. Here’s What I Found

Last updated by on 20 Comments

After a massive fail back in the fall with website reliability at healthcare.gov, I was curious what my user experience would be like TODAY – and I was REALLY curious what insurance premium quotes on the new public insurance exchanges look like.

So I went exploring, did some cost comparisons, and even tested out public versus private exchanges. What I found was… surprising. I’ll share what I found, but the purpose of this post is to inspire you to go exploring as well – and share what you found in the comments.

If you are unemployed, self-employed, have thoughts about being self-employed, or your employer offers no health insurance or very poor insurance – you’ll definitely want to pay close attention.

Getting a Premium Quote on Healthcare.gov

obamacare-pricesI had hoped to get a healthcare.gov premium quote back in November when the health insurance exchanges first opened. I left demoralized. I didn’t see any easy way to get a quote without creating an account and entering a lot of personal information.

That has changed.

Now, you simply go to this healthcare.gov premium quote tool (accessed by clicking “See Plans Before I Apply”) on the healthcare.gov home page.

To get a quote, you need to enter:

  • if you are looking for insurance for just yourself, family, or a business
  • whether you are looking for health or dental insurance
  • state and county you live in
  • age
  • if you have employer coverage
  • household income to determine subsidy eligibility

No personally identifiable information is required. You can get a quote in under a minute.

Note: your experience with the healthcare.gov website will vary based on state. If you reside in a state that partnered with the federal government to administer the exchange, then you will get a quote on healthcare.gov. However, if you reside in a state that manages its own exchange, you will be re-directed to that site.

Insurance Premiums Rates on Healthcare.gov

I’ll share what I found for myself for what looked to be the two most attractive plans, but plan details and rates are going to be different for every state. And you may have different needs/preferences – so do your homework before making any selections.

My profile:

  • Looking for health insurance (not dental) for my wife and myself
  • both in lower 30′s in age
  • healthy without any high prescription costs or ongoing medical issues
  • located in Michigan
  • we have employer health insurance, but I selected “no” on the drop-down so I could get a quote
  • we are at an income level that doesn’t qualify for subsidies

For a “Blue Cross Select Bronze” plan:

Premium Costs:

  • For both my wife and I: $351/month, $4,212/annual.
  • For just myself: $177/month, $2,124/annual.

To summarize the plan benefits:

  • $11,900/yr. deductible (half that for individual)
  • $12,700/yr. out of pocket maximum (half that for individual)
  • Primary Doctor: $30 Copay after deductible
  • Specialist Doctor: $50 Copay after deductible
  • Generic Prescription: $4 Copay after deductible
  • ER Visit: $250 Copay after deductible and 40% Coinsurance after deductible
  • HSA eligible

What is a “bronze plan”? The metal tiers look like this:

  • Platinum
  • Gold
  • Silver
  • Bronze
  • Catastrophic (only available to those under age 30)

The higher the tier, the more in premiums you pay, but the lower your out of pocket costs will be. Covered California (California’s public exchange) had this comparison of out of pocket costs (not sure if this is applicable nationwide):

obamacare_metal_tiers

The bronze plans are designed to be similar to HDHP’s – where you pay more of the cost for your actual care, but less in premiums. They are an attractive option for those who are young, healthy, and have few projected health care expenses. They are also HSA eligible (or at least the plan I looked at was).

But what if you’re not so young and healthy? Here’s a look at an alternative “Silver” plan…

Blue Cross Select Silver:

Premium Costs:

  • For both my wife and I: $455/month, $5,460/annual.
  • For just myself: $231/month, $2,772/annual.

To summarize the plan benefits:

  • $3,300/yr. deductible (half that for individual)
  • $12,700/yr. out of pocket maximum (half that for individual)
  • Primary Doctor: $30 Copay before deductible
  • Specialist Doctor: $50 Copay after deductible
  • Generic Prescription: $4 Copay after deductible
  • ER Visit: $250 Copay after deductible and 30% Coinsurance after deductible
  • Not HSA eligible

Comparing the Bronze and Silver Plans

Being young and relatively healthy, I went in to this premium search thinking that there would be no way I’d select anything other than a plan with the lowest possible premium. After comparing plans… I’m not so sure. Here’s why:

For an annual premium difference of $1,248 (for 2) and $648 (solo) more for the Silver plan, I would lop off $8,600 (for 2) and $4,300 (solo) in annual out of pocket deductible risk (if something very costly like major surgery, disease, or a newborn were to happen).

In other words, if in just one of every seven years I have something costly come up that takes me up to my out of pocket deductible, my premium savings for going with the lower cost Bronze plan would be completely wiped out. If I have two years in seven with high costs – I’ve lost a good chunk of money with the lower cost Bronze.

This is an oversimplification and for illustrative purposes, but you get the idea. I did not think the deductible difference would be that dramatic for that low of a premium difference. If I look back on the last seven years, I probably would have come out ahead with the bronze plan. The next seven? I would consider myself very lucky not to have a pricey year or two. But I’m not an insurance actuary, so who knows.

Also noteworthy – any costs would have a 30% co-insurance with the silver plan, but 40% with the bronze.

And on top of that, the co-pays for visits to a primary care doctor for the bronze plan are after deductible, while the co-pays for the silver plan are before deductible. This means, 100% of the cost of the visit would not be covered with the bronze plan until you met your full annual deductible.

If you are discouraged from the getting essential medical care for fear of paying a high annual deductible, is that worth the premium savings, when they are not overly significant? (curious to hear your answer to that in the comments).

One big comparative downside to the silver plan versus the bronze is that it is not HSA eligible, for new contributions.

Catastrophic Plan Costs for those Under Age 30

Then there’s the healthcare.gov catastrophic plan – only available to those under age 30 (unless you claim a “hardship exemption”). I’d be doing a disservice to my audience (mostly under 30) without covering.

So, lets go back in time to the age of 25… ah, yes…

Premium Costs:

  • For both my wife and I: $248/month, $2,976/annual.
  • For just myself: $124/month, $1,488/annual.

To summarize the plan benefits:

  • $6,350/yr. deductible per individual
  • $6,350/yr. out of pocket maximum per individual
  • Primary Doctor: $30 Copay before deductible
  • Specialist Doctor: No Charge after Deductible
  • Generic Prescription: No Charge after Deductible
  • ER Visit: No Charge after Deductible
  • Not HSA eligible

Hmm…. that doesn’t sound so catastrophic at all! This is a very affordable and surprisingly generous plan – and if you are under age 30 and do not have health insurance because you are afraid of the cost – you should definitely consider it.

But there is one big downside to the catastrophic plans: they are not eligible for the government subsidy. So you may actually pay less, if you have a lower income, for a higher service plan that is eligible for a subsidy. If your income is over the level eligible for subsidy, this will not matter.

It’s also surprising and disappointing that the catastrophic plans are not HSA eligible (at least the Blue Cross plan I viewed was not).

Public Exchange vs. Private Exchange

I also wanted to find out private exchange prices versus the public exchange. Prior to the public exchange launch, I was left with the impression that private exchanges would still exist and there would be a service offering on them that was significantly different than what I found on the public exchanges. In particular, I thought I would see lower premium HDHP-type plans that did not meet public exchange eligibility requirements.

The biggest private exchange that I am aware of is eHealthInsurance.com. I put in the same parameters highlighted earlier to see what I’d find. The results were different, but not in the ways that I was expecting:

  • HAP, Humana, United Health, and Aetna all offered plans that were not on healthcare.gov (versus just Blue Cross and Priority Health on the public exchange). However, the prices were not competitive to the public exchange plans, surprisingly.
  • Public exchange plans were in the private exchange, all with the same prices, plans, and plan details. I was not expecting to see them there.
  • There were not any lower premium HDHP plans in the private exchange, as I was hoping for.

Also, plans purchased off of private exchanges are not eligible for subsidies. I found it odd that the public exchange plans were, in fact, in the private exchange and have similar pricing, but with the one huge downside of not being eligible for subsidies.

You may have different results in your state, but if you don’t see cheaper plans on a private exchange, then is it worth closing the door on a subsidy? Probably not.

Speaking of those Subsidies

All prices that I’ve shared here are without subsidy. If you purchase a plan through a public exchange you might be eligible for an Advance Premium Tax Credit (APTC) (aka the government subsidy) to help you pay for your premium each month. Eligibility is dependent on your income level (up to 400% of the federal poverty level) and size of household.

There is a premium subsidy calculator here, to help you determine what subsidy, if any, you might be eligible for. And here’s a chart to help you determine if you may be eligible.

As noted previously, catastrophic plans do not qualify for subsidies.

Healthcare.gov Premium Quote Discussion:

  • What premium/plan results did you find in your state?
  • Are these premiums/plans higher or lower cost than you had anticipated?
  • Have you purchased a plan off a public exchange?

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About the Author
I am G.E. Miller, & this is my story. My goal is financial independence ASAP. If you share that goal, join me & 7,500+ others by getting FREE email updates. You'll also find every post by category & every post in order.


20 Comments »
  • Alicia says:

    I found and applied for a Humana catastrophic plan (I’m 26) for $108 a month. This saves me over $4000 in premiums over adding myself to my husbands plan.

    • G.E. Miller says:

      Wow – that sounds like a great find. Sounds like your husband had a plan through work? Was it a good plan? I would hope so for $4k per year. There are some very good plans (for someone in their low 30′s) for less than $2k total – without any work sponsorship or subsidies.

  • SD Lurker says:

    My 28-yr old son had a Kaiser plan (CA) for $210/mo that was canceled as of 12/31/2013.

    Kaiser offered a ACA-compliant replacement Bronze plan for $208/mo but with much higher deductible, copayment & out-of-pocket maximums. To get an ACA plan comparable to the canceled plan it would cost $290/mo – a 39% increase over his old plan. (Washington DC has a strange definition of “affordable”).

    With further research we found an insurance broker that offered a “grandfathered” Anthem Blue Cross plan that didn’t have all the bells and whistles of his former plan but was comparable to the ACA bronze plan and perfectly adequate (he’s in good health) for a monthly premium of $143. Of course this plan will only be available for a year but will tide him over while we see how the whole ACA program shakes out.

    • Steve M says:

      It’s extremely unlikely the $290 plan is comparable to his canceled plan. The reason it was canceled in the first place was because its benefits didn’t meet the minimum requirements of Obamacare. As far as I am concerned, he was wasting his money before.

      As a healthcare professional who just witnessed a young girl in her 20′s requiring extensive surgery after being struck by a car while jogging, I implore young people to get some kind of insurance. In a single moment, assuming she survives, her health care bills will be in the millions.

      • G.E. Miller says:

        Fully agreed – everyone should have health insurance – no matter how young or healthy you feel you are. It will protect you from a huge financial disaster, if nothing else. And you’re right, many inadequate plans no longer exist. Yes, prices have increased, but coverage has as well.

        • Rick says:

          Inadequate based on what? I don’t understand why we decided that we know what is best for everyone elses family. Why should we have to pay for a plan that includes maternity leave when that’s an impossibility for us? Ridiculous.

          • Cyrus T says:

            Two points:
            1) As mentioned earlier, comparing pre vs. post-ACA plans (especially any plan purchased in the individual marketplace) is really comparing apples to oranges. Pre-ACA, if you had come down with a chronic illness, your old plan would have dumped you after the term and forever more you would have no insurance. Eventually, it would have bankrupted your family (#1 cause of bankruptcy) which by itself shifts costs to society. After that, you would receive emergency care at society’s expense and once poor enough you’d qualify for Medicaid, also subsidized. In other words, ACA is making you pay for more of the risk you elect to take vs. put that risk onto society. If Republicans had any integrity, they’d admit that this is far more responsible than the previous (and rapidly collapsing) arrangement.

            2) On a related note, the idea that it’s unusually prescriptive “big government” for plans to require things like maternity coverage ignores the whole point of insurance. The reason why insurance works is because it’s better for a large pool of people with tiny risks of various things happening to agree to share risk vs. each of them being on their own. That means people with zero chance of prostate cancer share risk with people with zero chance of getting pregnant. To complain about coverage of maternity care because it doesn’t match one’s individual situation is thus just silly.

          • Rick says:

            No, what is truly silly is being forced to pay for something at gunpoint (why statists love the threat of force and violence from the state is beyond me) that you don’t need is ‘silly’.

          • SD Lurker says:

            The whole point of insurance, in a rational world, is to buy financial protection against risks that ACTUALLY apply to the insuree.

            Risks that apply only to men should be inherent in the man’s premium. Risks that apply only to women should be inherent in a woman’s premium.

            The problem with Obamacare is that a dozen clueless ideological politicians and staffers sitting in a backroom in Washington DC are crafting a one size fits all solution for 300 million Americans, refusing to divulge the details to the citizens who elect them and pay their salaries, and forcing a vote on a 3000 page bill that nobody voting for it has read. Is this REALLY the way we want our elected representatives to make policy? If the answer is yes, then we have given away the American dream to a political class that considers us to be manageable sheep.

            The fact that Obamacare is turning into a wreck does not surprise me – it was totally predicted by many, but fell on deaf ears.

            What does surprise is that freedom-loving Americans did not rebel fiercely against the arrogant, corrupt process that brought such sweeping social legislation it into being.

          • Tom says:

            Now I lean libertarian and would prefer to have fewer government mandates (not excluding Obamacare) but explain to me how “rebelling fiercely” solves anything. If anything I’d go for social disobedience before pulling out the guillotine.

            I am also agreed that the process is what is causing lots of these problems, but I’m sick of both sides casting blame and want to hear solutions. Term limits is the best one I’ve heard as of yet.

            I love a good political discourse – not sure that’s what GE intended writing this :) – but let’s keep it positive and productive!

      • SD Lurker says:

        Everybody’s circumstance are different. But your assessment is wrong. Each individual should determine what benefits and risks he wants in his/her plan. That’s called individual liberty. Part of the higher costs of the ACA plans are premium charges for coverage of problems he would never incur (maternity, prostate exams, annual breast exams, ED, etc.). That excess premium built into the one-size-fits-all ACA plans is used to subsidize others who then pay less for their insurance.

        My son could have qualified for subsidies but refuse to ask others to pay for his insurance.

        The plan he has now signed up for provides adequate protection against catastrophic events. In the last two years he has only seen a health care provider twice for a total cost of about $240.

        Auto accidents are covered by his auto policy upto $20,000 so his deductible and out-of-pocket limits will kick in quickly. He also has a supplementary accident insurance policy at very low cost.

        So many people are insured redundantly without thinking or realizing it. A good insurance agent can help you look at your total insurance situation to avoid doubling up on insurance costs.

  • Jeremy says:

    Looks like Michigan has some better options than Indiana. The catastrophic plan in Marion County is $400/month with a $12,700 deductible! (for two people, 29 and 28 years old)

    What I found interesting is what a difference the ‘does your employer offer insurance’ question makes. With employer offered insurance, we’re ‘covered’ and not eligible for subsidies. The lowest bronze plan is $469/month $10,000 deductible. Saying ‘no, my employer doesn’t offer coverage’, I’m eligible for subsidies and the lowest bronze plan is $334/month $10,000 deductible. (cheaper than the catastrophic plan!)

    Luckily, I’m one of the fortunate with a great insurance plan offered by my employer. We get Silver/Gold comparable coverage + dental with a $6,000 out of pocket max for $105/month.

  • Ron Ablang says:

    It’s good to have a full time job w/ medical benefits. I got quotes through coveredca.com (I’m in CA) and the quotes are high for a family of 4. Scary.

  • capercat says:

    I have not had health insurance, I self pay (they charge me half or less when I say I self pay). Let me get this straight. You pay a premium every month, then until you have spent the entire deductible on office visits, prescriptions, hospital, etc; Then you are entitled to use the co-pay of $30.00 per visit (or whatever amt for the plan you chose.) Once you have gotten to the end of the 12th month you get to start all over with the annual deductible again. So for example if the premium is 400/mo and a 6000/annual deductible, during that year that is $10,800 you have to pay out to get the first $1.00 of them paying something. Sounds crazy to me.

    • G.E. Miller says:

      It’s not crazy if you get diagnosed with cancer, get in a major auto accident, or have a massive heart attack that requires surgery. That’s what insurance should truly be looked at as – protection against catastrophe. It’s not a value plan.

    • Tim says:

      Agreed, I would much rather save/invest that money while healthy than basically throw it away every month just so that the insurance company can fight tooth and nail to not pay out a single cent should something actually happen >.>.

  • Concerned says:

    Help me out if I’m misunderstanding something. It seems that HDHP’s are disappearing from the marketplace to be replaced with higher premiums and “better” coverage.

    For those who have a fully funded emergency fund and are truly only concerned with the catastrophic events (like cancer or a major auto accident), is a private individual HDHP no longer available?

    • SD Lurker says:

      You might try looking into Cancerinsurance.com. You can get various amounts of benefits upto $50,000 for about $15/month for a 20-something that covers any type of cancer.

      For people in the 20-something age group the statistics for any type of cancer (govt statistics) are about 50 occurrences/year per 100,000 so the chances of occurrence of any type of cancer are about 0.05% per year per individual or about 0.5% for your twenties.

      They also have a separate program for critical illnesses (heart attack, stroke and some others) for about the same amount. So for about $30/month you could provide $50,000 benefit to cover a variety of common major illnesses. These rates are probably only if you have not experienced these illnesses previously which would apply to most in the 20-something category.

      Although these are modest premiums, they are still relatively high when compared to the actual statistical risk incurred by the insurers for the 20-something age group – so they have a healthy margin in the premium. Just another tool to consider.

  • Amanda M. says:

    One thing you said may be slightly misleading:
    “And on top of that, the co-pays for visits to a primary care doctor for the bronze plan are after deductible, while the co-pays for the silver plan are before deductible. This means, 100% of the cost of the visit would not be covered with the bronze plan until you met your full annual deductible.

    If you are discouraged from the getting essential medical care for fear of paying a high annual deductible, is that worth the premium savings, when they are not overly significant?”

    One big change with ACA (where many of the higher expenses came from) is that all preventative visits must be covered to be compliant, 100% covered, no deductible, no co-pay, no matter the terms of the plan. All of the marketplace plans cover yearly “well” visits and vaccinations (the website shows a huge list of what must be included for marketplace plans – https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=1 ). Now if you go in with the flu, obviously that’s not a well visit, but you could get the immunization to prevent the visit for free. I just wanted to make sure people were aware of this.

  • Wes says:

    One thing that was not mentioned is the difference in the network of doctors if a plan is purchased on or off the exchange. Off exchange plans will have a much larger network of doctors. Those who purchase off exchange may find it easier to be seen when they need to. The on exchange network of doctors depending on each plan of course will be smaller and will have a vast influx of new participants, thus creating a bottleneck. The only reason one would want to purchase on exchange would be if they qualify for subsidies.

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