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Individual health insurance policies are plans that you buy for yourself and your family if you do not receive coverage through work or Medicaid.
How to compare health insurance quotes and plans
All marketplace health insurance policies will have three different costs to compare: a premium, deductible and out-of-pocket maximum.
When looking for the right health insurance plan, you must understand and compare each of these policy components and then choose a policy that provides health coverage at an affordable cost. This involves looking at the different coverage levels, also called tiers (Catastrophic, Bronze, Silver, Gold and Platinum), and comparing each provider network (PPO, EPO, HMO and POS).
The premium is the price of health insurance and what you will pay to continue to be covered. Premiums for marketplace plans are a monthly payment that you will be billed for by the health insurer that you choose. When comparing health insurance plans, evaluate the premiums and calculate, based on your income, which policies are affordable financially.
The deductible is the amount of medical care you must pay for in full before your plan's benefits kick in and allow you to pay a portion of your medical costs called the coinsurance or copayment. For example, you could pay the full cost of an X-ray before you reach the deductible. Some services, such as preventive care, are excluded from a plan's deductible, but typically, your medical care is more expensive at the beginning of the policy year before your spending reaches the deductible.
The out-of-pocket maximum is the limit on how much you could spend on medical care in a year. After your medical spending reaches this amount, the insurance company pays for 100% of the cost of covered health services. The out-of-pocket maximum protects you from very high costs if you need expensive or ongoing medical care. Remember that the calculations are based on medical spending. This means what you spend toward your deductible as well as copayments and coinsurance will count toward reaching your out-of-pocket maximum. However, the monthly bills you pay for the insurance plan are not included.
Both the out-of-pocket maximum and deductible are essential to consider when evaluating the affordability of policies. Since you are responsible for all expenses before the deductible, if you choose a deductible that is too high and you have a large medical expense, you may not be able to cover the cost of treatment. You should try to predict your medical expenses for the next year and choose a plan that will provide you with the most benefits possible combined with a deductible that you could afford to reach.
How to compare metal tiers of health insurance
When comparing health insurance plans, tiers can help you understand how the cost of a plan relates to the level of medical benefits you get.
In most state health insurance exchanges, there are five coverage levels available for purchase: Catastrophic, Bronze, Silver, Gold and Platinum. Choosing the right health insurance plan will require you to identify which plan tier is best for your current health and financial situation.
Catastrophic and Bronze health plans have the cheapest monthly costs, but you'll pay a larger portion of your medical expenses because plans have high deductibles and out-of-pocket maximums. For this reason, Bronze and Catastrophic plans are best for individuals who are in great health and do not expect to have large medical expenses during the year. Keep in mind that Catastrophic plans are not eligible for premium tax credits.
Silver metal tier plans are middle-ground policies with modest premiums and deductibles. These plans are best suited for individuals or families with average health insurance needs and household income. The federal government also allows Silver health insurance policyholders to receive cost-sharing reductions if their household income falls below 250% of the federal poverty level — for example, earning less than $69,375 per year for a family of four. This benefit will allow you to pay less in coinsurance, copays and deductibles.
Gold and Platinum health insurance plans have the most expensive rates but the lowest deductibles available on the federal marketplace. When comparing these health insurance policies to those in other tiers, you should consider your family's health insurance needs for the upcoming plan period. If you expect a large number of medical expenses, like prescription drugs or surgeries, then choosing a Gold or Platinum plan with a low deductible could be a cost-effective and cheaper option, despite the higher premiums.
How to compare health insurance networks
A key aspect of health insurance that you should consider when comparing plans is the type of provider network each one offers.
This plan type will determine where your medical care will be covered and the rules of how your coverage works.
Each health policy will be classified into one of four different network types: health maintenance organization (HMO), preferred provider organization (PPO), exclusive provider organization (EPO) or point of service (POS). The main factors that you need to consider when comparing networks are whether the insurer needs a primary care physician (PCP) for referrals and the level of expenses you are responsible for if you receive out-of-network coverage.
A primary care physician is typically a family doctor or general practitioner who provides you with basic care services and recommendations to see specialist doctors if needed. If you choose a provider network that does not require a primary care physician, then you can seek out care from specialists on your own instead of getting referrals.
|Average monthly cost||$457||$508||$522||$531|
|Specialist care without a referral||Sometimes|
Policy costs are the national average for a 40-year-old.
Find ACA plans in your state
Every type of health insurance network has access to groups of doctors and providers. When choosing a plan, it's important to check that your preferred doctors and medical facilities are in the network because going out-of-network can either cost more or not be covered. For example, if you currently visit a specialist chiropractor, make sure the plan that you buy would cover their services. Similarly, if you previously had health insurance and had a primary care physician that you liked, make sure they are in the new plan's network before purchasing the policy.
Private health insurance and short-term plans
Private health insurance is another way of describing an individual or family health insurance plan that's sold by a private insurance company.
A private health insurance plan is best for those who don't have other coverage through an employer or through a government program such as Medicaid or Medicare.
These plans cover both essential health services and prescription drugs, and policies have the same cost structures as an employer plan with a deductible, copays and an out-of-pocket maximum to cap your medical expenses. You can purchase plans through a broker, an agent, the government marketplace, or directly from an insurance company.
Alternatively, if you have a coverage gap between two health insurance plans, we recommend a short-term health insurance policy.
Short-term plans are cheap, costing $100 per month in some cases, but plans are not regulated in the same way as private or individual health insurance, so the benefits can vary widely. For example, some plans could have deductibles as high as $5,000 or $10,000 before the policy would start covering your care. Other policies could exclude coverage for pregnancy, mental health or prescriptions. Each plan will have a different set of limitations, and because these policies typically have less coverage, you should only consider short-term plans as an option if you miss open enrollment or are between jobs and need health insurance coverage.
Frequently asked questions
How much does individual health insurance cost?
Health insurance costs $541 per month, on average, for an adult in the United States. However, the cost of plans will vary depending on your age, location and the level of coverage you choose.
What are the cheapest health insurance quotes I can get?
The most affordable health insurance is Medicaid, but to qualify, you must have a low income of less than $18,754 per year, in most states. If you don't qualify, you can choose the cheapest health insurer in your state, which could save you more than $100 per month compared to typical rates.
What are the best health insurance companies?
The overall best health insurance company is Blue Cross Blue Shield. However, health insurance plans vary widely, making it important to compare plan options based on your location, age, preferred doctors and medical needs.
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Sources and methodology
The average cost of health insurance is aggregated using quotes for a 40-year-old individual sourced from Public Use Files (PUFs) on the Centers for Medicare & Medicaid Services (CMS) government website. Plans and providers for which county-level data was included in the CMS Crosswalk file were used in our analysis; those excluded from this data set may not be considered.