Quick Look: The Best Private Health Insurance
- Best for Nationwide Coverage: Blue Cross Blue Shield
- Best for Access to Specialists: Kaiser Permanente
- Best for Same Day Coverage: UnitedHealthcare
- Best for Pharmacy Programs: Cigna
- Best for No Enrollment Period: Sidecar
If you aren't covered by an employer or through another group plan, you may be interested in private health insurance. But picking the right plan can be confusing. Use our guide to learn more and compare quotes.
Table of Contents [Show]
- Best Private Health Insurance
- What is Private Health Insurance?
- Private vs. Public Health Insurance
- How Much Does Private Health Insurance Cost?
- Private Health Insurance Comparisons: HMO vs. PPO vs. EPO vs. POS
- Finding a Private Health Insurance Plan
- Frequently Asked Questions
Best Private Health Insurance
Choosing private health insurance is a big decision. You can get multiple quotes fast through our website, but which plans are the best? Here are the 5 best health insurance companies, based on our research:
1. Blue Cross Blue Shield
# of Healthcare Providers
securely through Blue Cross Blue Shield Health Insurance's website
More Details(Video) Special enrollment periods for ACA health insurance
If you’re someone who travels for work or who splits time between locations, Blue Cross Blue Shield might be the plan for you. Blue Cross Blue Shield has plans and network providers in every state.
It also has coverage options if you travel or live overseas. Blue Cross Blue Shield is made up of independent companies, so you choose a plan that serves your area and let the local company know about your travel or other needs.
2. Kaiser Permanente
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# of Healthcare Providers
Kaiser Permanente isn’t available everywhere, but if you’re in one of its service areas, it’s worth a look. Kaiser Permanente is unique in that it’s both an insurance plan and a care provider. This means better coordination when it comes to your care.
In some of Kaiser’s service areas, you can go to a Kaiser facility for routine care. You can see multiple providers and pick up prescriptions all in the same place.
More Details(Video) ACA Special Enrollment Periods (SEPs) Explained
# of Healthcare Providers
Do seniors need private health insurance? Most of them have Medicare, right? Medicare covers a lot, but it has a lot of out-of-pocket costs, too. Many seniors purchase a private Medicare Supplement or Medicare Advantage plan to work with their public Medicare coverage.
UnitedHealthcare has partnered with AARP to offer a variety of plans for seniors. It offers Medicare Advantage plans, which typically have low premiums and include prescription coverage. It also offers Medicare Supplements, which typically have higher premiums but lower deductibles.
# of Healthcare Providers(Video) Medicare Special Enrollment Periods
Some insurance companies can be a challenge to contact. They might only be available during business hours, which is when most of us work.
Cigna is available 24/7, which makes it easy to talk to someone when you need to. It also offers a user-friendly mobile app so that you can access your insurance info on the go. Cigna offers affordable copays and low-cost preventive care.
# of Healthcare Providers
See any doctor
securely through Sidecar Health Access Plan's website(Video) ACA Special Enrollment Periods - Explained
Plans referred to above are excepted benefit fixed indemnity insurance products marketed and administered by Sidecar Health Insurance Solutions, LLC and underwritten by Sirius America Insurance Company or United States Fire Insurance Company, depending on the state. As an excepted benefit plan, it does not provide comprehensive/major medical expenses coverage, minimum essential coverage, or essential health benefits. You cannot receive a subsidy (premium tax credit and/or cost-sharing reduction) under the ACA in connection with your purchase of such an excepted benefit fixed indemnity insurance plan. Also, the termination or loss of this policy does not entitle you to a specialenrollmentperiod to purchase a health benefit plan that qualifies as minimum essential coverage outside of an openenrollmentperiod. Coverage and plan options may vary or may not be available in all states.
Sidecar is a health insurance quote aggregator, meaning you fill out some information about your age and health history and it populates the best carriers based on what you told them.
What is Private Health Insurance?
As the name suggests, private health insurance can be any plan that you purchase directly, rather than through an employer-sponsored group plan or a federally-sponsored plan.
Private vs. Public Health Insurance
What’s the difference between private and public health insurance? Let’s take a closer look.
- Public: Public health insurance is funded and supported by a federal or state government. In the U.S., the 2 most common public health insurance plans are Medicare and Medicaid. It’s important to note that you may have to pay for public health insurance. For example, people with Medicare pay a premium for Part B.
- Private: Private health insurance is insurance that isn’t offered by the federal or state government. You can purchase private health insurance through an employer, through your state’s Marketplace or directly from an insurance company.
Both types of health insurance have out-of-pocket costs.
How Much Does Private Health Insurance Cost?
Insurance companies decide on premiums based on several factors. These include:
- Your age: The older we are, the more likely we are to need healthcare. To account for this, insurance companies charge higher premiums to older plan members.
- Whether you use tobacco: Smoking and using tobacco increases the risk of developing health issues.
- Your location: Where you live has an impact on your health. It also impacts how much competition there is among insurance companies and how expensive it is to provide healthcare.
- The number of people on your plan: An individual plan is less expensive than a family plan.
- Level of coverage: Every policy is different, and when you have more coverage, you tend to pay for more. If your deductible is higher, you pay less, etc. Make sure you know what sort of coverage you’re getting so you can compare that with how much you will pay each month.
Insurance companies can’t charge you a higher premium based on your gender or on your specific health history. You can’t be charged a higher rate if you have diabetes, for example.
Many people get private health insurance through an employer. Employers typically pay for part of the costs of health insurance and employees pay for the rest. Employees paid an average of $1,427 annually for individual coverage in 2018, according to The Commonwealth Fund. They paid an average of $5,431 for a family plan. This comes to $118 per month for an individual plan and $452 per month for a family plan.
Private health insurance purchased on your own (not through an employer) is significantly more expensive. According to eHealth Insurance, the average cost of an individual plan purchased on your own is $440 per month. The average cost of a family plan is $1,168. This comes to $5,280 per year for an individual and $14,016 per year for a family.
The first step to finding affordable health insurance is getting multiple quotes. Here at Benzinga, we have a simple tool that allows you to get quotes fast by entering your ZIP code. As you review your quotes, keep in mind that every insurance company determines its rates differently. The cost of health insurance is about more than just your premium, though. Here are a few other costs to consider:
- Deductible: Your deductible has a big influence on your health costs. Your deductible is the amount you pay for covered health care before your plan starts paying. The average deductible in 2018 was $4,328 for an individual plan and $8.352 for a family plan, according to eHealth Insurance.Remember, higher deductibles reduce your premiums, but they result in greater out-of-pocket expenses.
- Copayment: Your copayment, or copay, is a fixed amount you pay for a service. You might have a $10 copay for a doctor’s visit and a $20 copay for a specialist visit.
- Coinsurance: Coinsurance is like a copay, but instead of paying a fixed amount, you pay a percentage of the cost. If your plan has a coinsurance of 20% and your doctor visit costs $200, you would pay $40.
- Out-of-pocket maximum: Your out-of-pocket maximum is the most you pay would pay out-of-pocket in a year. This total doesn’t include your premiums. Plans sold on your state’s health insurance Marketplace have a maximum out-of-pocket limit of $8,200 for individual plans as of 2020. The maximum out-of-pocket limit for family plans is $16,400.
Private Health Insurance Comparisons: HMO vs. PPO vs. EPO vs. POS
Another factor to consider when it comes to how to get health insurance is the plan type. Here are the 4 most common types of plans:
- HMO: An HMO is a health maintenance organization. With an HMO, you choose a primary care doctor. If you need to see a specialist, you typically need to get a referral from your primary care provider. HMOs have a provider network. You may not be able to see providers outside of your network. If your plan allows you to see out-of-network providers, you will have to pay more.
- PPO: A PPO is a preferred provider organization. It allows you more flexibility than an HMO. You typically don’t need a referral to see a specialist. You can see providers outside of the provider network, but you will pay a bit more.
- EPO: An EPO is an exclusive provider organization. It combines aspects of an HMO and a PPO. You have the more restrictive network associated with an HMO. If you see an out-of-network provider, you pay significantly more. You also have the freedom to see specialists without a referral.
- POS: A POS is a point-of-service plan. You can see any provider in your network without getting a referral. If you want to see an out-of-network provider, you do need a referral.
Finding a Private Health Insurance Plan
Finding the best health insurance can feel like a process. As you review plans, keep your priorities in mind. If you have a doctor you like, look for a plan that has your doctor in-network. If you take prescriptions, find out whether your prescriptions are covered. If you want low premiums, keep an eye on the deductible to make sure you don’t end up with unexpected out-of-pocket costs.
Choosing an insurance plan is a balancing act. You want it to fit your budget and your health needs. You want good service and convenient care. Look for a plan that fits your lifestyle, and don’t hesitate to ask questions along the way.
Frequently Asked Questions
Can my private health insurance drop me from coverage?
In short, yes, your private health insurance coverage could choose to cancel coverage in certain situations. The quickest way to lose coverage, of course, is by not paying your premium. But you can also be dropped if you commit fraud or lie on your application.
Does private health insurance coverage take effect immediately?
This depends on the provider, but many enact waiting periods for coverage to take place. Others may offer same-day coverage. Check with your chosen provider to see their specific waiting period requirements.
What triggers special enrollment periods under the Affordable Care Act? ›
You qualify for a Special Enrollment Period if you've had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.What is the 8 month special enrollment period? ›
When working past 65: 8-month Special Enrollment Period. For people who work past 65 and qualify to delay Medicare with creditable employer coverage, there is an 8-month Special Enrollment Period that allows you to enroll in Part A (if you haven't yet), Part B , Part C and Part D without late penalties.Will the Affordable Care Act be available in 2023? ›
2023 Open Enrollment is over, but you may still be able to enroll in 2023 health insurance through a Special Enrollment Period.Does Medicare Part D have a special enrollment period? ›
During certain life events, you may be able to enroll in a new Medicare Part D plan. This period after a qualifying life event is called a Special Enrollment Period (SEP) . There are several conditions that may trigger an SEP, including loss of current drug coverage or moving outside your plan's service area.What are examples of a qualifying event? ›
- Becoming newly married or divorced.
- Having a baby or adopting a child.
- Experiencing a death of the insurer in the family.
- Losing health insurance coverage due to job loss.
- Losing eligibility for Medicare, Medicaid, or Children's Health Insurance Program (CHIP).
Using 2022 federal poverty levels, a family of four would qualify for subsidies with a household income of $27,750 to $111,000. A single person would qualify for subsidies if they made $13,590 to $54,360. (Federal poverty level amounts are higher in Alaska and Hawaii.)