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If you have a full-time job, your employer will likely pay for your health insurance. Your contribution through premiums is usually taken directly from your paycheck. Until you need it, you probably won’t think twice.
But what happens if your employer doesn’t pay for your health insurance? What if you are self-employed? If you need to find and pay for your own health insurance, it’s important to know how to pay your health insurance premiums. Find out more now with the Benzinga guide.
Paying health insurance premiums at HealthCare.gov
Paying your initial premiums on Healthcare.gov is easy if you have access to the Internet. It’s as easy as:
- Sign in to your Healthcare.gov account
- Choosing your app (you’ll find it under Existing Apps)
- By clicking on the blue button that says “Pay the monthly premium for your first health insurance”.
- “Pay the Health Plan Now” (The green button)
If your online payment does not go through, that means your account is not ready. Please contact us by email or phone to find out what steps you need to take next.
What is Health Insurance?
Just like car insurance covers your car, health insurance is there for you in case you get sick or injured. Most major insurance companies sell typical health insurance policies that pay for items like:
- Surgery
- Chronic disease
- Cancer
- Prescription drugs
- Rehabilitation
- psychological services
- Physical and occupational therapy
- Short and long term care
- Vision
- Dental
Health insurance is there for you if you get sick or hurt in an accident, but it also covers preventative measures like doctor visits, exams, and tests. Many policies also offer dental, vision, and hearing coverage, although these can sometimes be added later.
Health insurance is not free. For your health insurance, you make payments known as premiums, usually in monthly installments. Even if you have health insurance through your employer, you typically make your health insurance payments every month, even if they come directly from your paycheck.
When it comes time to use your health insurance, it’s not free either. There are fees and expenses, including:
- Deductibles: Every time you use your health insurance, you must pay a deductible. A deductible is the insured’s contribution to medical expenses. Deductibles are not required each time you use your health insurance, but they usually have an equivalent annual amount. When it comes to your health insurance costs, the higher the deductible, the lower the premiums, and vice versa. Deductibles reset annually.
- copays: A copay is a set fee you pay each time you see your doctor or specialist or receive specific types of health care services. Typical copays start around $10 but can be as high as $35. Copays also apply to prescription drugs, although many health plans do not require a copay when you visit your primary care doctor or for prescription drugs.
- Coinsurance: First, you pay your deductible, then there’s coinsurance. For example, let’s say your deductible is $500 and your coinsurance is $5,000. If you need surgery, you pay the $500 deductible first. If the procedure costs $50,000 and your coinsurance is 20%, then you pay $10,000 and your health insurance provider pays the remaining $40,000. High coinsurance costs generally equate to lower premiums.
types of health insurance
There are two main types of health insurance: public and private. While public health plans like Medicare and Medicaid are government programs, private plans are paid for by the individual or their employer.
private health insurance
Private health insurance is divided into four main categories: HMO, PPO, EPO, and POS.
- HMO (Health Maintenance Organization): HMOs have their own networks of hospitals, doctors, and health care providers. HMO policyholders must remain within this network to qualify for coverage. Because the insurance company deals with in-network providers, HMOs are often more affordable.
- PPO (Preferred Provider Organization): While with an HMO you must stay within its network, a PPO allows you to choose your own doctor and health care providers. With a PPO, you can see any doctor you want. Due to these less restrictive requirements, PPOs are more expensive than HMOs and often have a higher coinsurance rate.
- EPO (Exclusive Provider Organization): Like an HMO, an EPO offers a local network of providers for the policyholder to choose from. EPO plans are good for people who don’t plan to use their health care as often. EPOs offer higher deductibles and more affordable premiums.
- POS (Point of Service Plan): A POS is a managed health plan that is sort of a hybrid between an HMO and a PPO. Like an HMO, the policyholder has a list of in-network providers. The policyholder must pay for out-of-network providers, but what makes a POS different from an HMO is that he will pay for out-of-network services if his primary care doctor makes a referral. .
public health insurance
Public health insurance includes all types of coverage provided by the government: federal, state, and local. The main types of public health insurance include:
- state health insurance
- Health insurance
- CHIP (Children’s Health Insurance Program)
- VA (Veterans Administration)
- CHAMP-VA
- IHS (Indian Health Service)
While Medicare is a federal program for people age 65 and older (and long-term disabled), Medicaid is free to those who qualify and is administered at the state level. CHIP is available to children from low-income families who do not qualify for Medicaid. The Veterans Administration provides medical assistance to eligible veterans of the United States military, while CHAMP-VA, administered by the Department of Veterans Affairs, also covers veterans, their dependents, and survivors.
Other state and local managed health services are offered through public clinics and hospitals. While not technically health insurance, they do offer financial and medical assistance to those who qualify.
What is a health insurance premium?
Your health insurance premium is the amount you pay each month for your health insurance. The amount to pay depends on:
- Your age
- Your Health
- plane type
- Habits such as drinking and smoking.
- Coverage amount
- deductible amount
Health insurance is funded through your monthly premiums, but the premiums don’t cover everything. In addition to the premiums, when you use your insurance you have to pay an annual deductible.
There are also coinsurance and copays. The price of your premiums can sometimes be lowered with a premium tax credit. If you have Medicare, you may qualify for a Medicare Savings Plan that pays some or all of your monthly premiums.
Who pays your health insurance premiums?
Who pays your health insurance premiums depends on the type of insurance you have. If you have a group policy like through your employer, your employer pays your insurance premiums with funds from your paycheck. If you have an individual policy, you pay the premiums.
If you have public health insurance such as Medicare Part A, hospitalization is free. Parts B and D (medical services and prescription drugs) are paid by the beneficiary. Public health insurance like Medicaid is free, but hard to qualify for. Even if you don’t qualify for Medicaid, your child may be eligible for CHIP.
Advantages of Lump Sum Health Insurance Payments
Lump sum health insurance is now more popular than ever. Lump sum payments increase efficiency and quality of care. Lump-sum payments help improve coordination among medical facilities and make cancer screening and treatment more efficient and affordable. Lump sum payments help reduce deductibles and out-of-pocket costs.
Lump sum payments also help those suffering from debilitating injuries or illnesses such as a sudden heart attack or stroke. Prepayment allows the policyholder to focus 100% on recovery, not paying the bills and wondering if he has paid his premiums.
It also helps defer costs on the spot like deductibles and coinsurance. Cash benefits are paid directly to the insured and can be used as the policyholder sees fit. Lump sum health insurance premiums help cover:
- Deductibles
- Coinsurance
- Medical prescription
- rehabilitation
- unexpected expenses
Cash benefits can even pay for household expenses such as rent, mortgages, and utilities while the insured is disabled.
Compare Health Insurance
When it comes to comparing health insurance premiums, knowledge is king. Benzinga has a wide range of articles on health insurance, from what to look for in an insurance policy, what type of insurance is best for you, and most importantly, how to keep those health insurance premiums low.
In the end, no matter how good the policy is, if you can’t meet your monthly premiums, you may be left with the bag. Compare health insurance plans below.
Educational guides on health insurance
Whether you’re looking for private health insurance, it’s time to sign up for Medicare, or you need temporary help now, Benzinga has tons of articles and educational guides on health insurance and health insurance premiums. Check out these great health insurance education guides from Benzinga.
Frequent questions
Why is my monthly health insurance premium so high?
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Why is my monthly health insurance premium so high?
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Philip Loyd, Licensed Insurance Agent
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If your health insurance premium is unusually high, maybe you should shop around. Spending time to get the best deal is not a waste of time. Unfortunately, if you’re in a high-risk category, even comparison shopping may not lower your premiums. If you have a chronic illness, have pre-existing conditions, or are a smoker, your premiums will naturally be high. Some states also have higher monthly premiums.
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Benzinga
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