What Will Marketplace Insurance Cost Me?

Nov. 11, 2013

It’s perhaps the most common question people might ask: How much will health insurance purchased on the Affordable Care Act’s (ACA’s) health insurance marketplace cost?

This installment of the Texas Medical Association’s (TMA’s) “Hey, Doc” weekly education campaign answers that question and more.

TMA’s ninth week of “Hey, Doc” education programming

What will it cost me to buy this insurance?

Your insurance costs depend on a lot of things like where you live, your age, how many people are in your family, the services you need, and whether you smoke. And your income determines whether the federal government will help you pay for your insurance.

What you pay also depends on which category of insurance you choose in the marketplace: bronze, silver, gold, or platinum. In bronze and silver plans, you might pay a lower monthly charge, called a “premium,” but you might have to pay a higher cost later when you use the insurance. The opposite happens when you buy gold and platinum plans; they tend to have higher premiums and lower out-of-pocket costs.

Here’s an idea of what those costs might look like, on average:

  • In a bronze plan, insurers pay for 60 percent of the charge for medical services; patients, 40 percent.
  • In a silver plan, insurers pay for 70 percent; patients, 30 percent.
  • In a gold plan, insurers pay for 80 percent; patients, 20 percent.
  • In a platinum plan, insurers pay for 90 percent; patients, 10 percent.

You won’t know your costs for sure until you fill out a marketplace application. But until then, you can get a rough idea using this calculator tool created by the Kaiser Family Foundation.

And remember, regardless of whether a plan is bronze, silver, gold, or platinum, don’t forget to check out the other details besides costs, like the kind of insurance and the doctor and hospital networks. Those things are important to keep in mind when comparing your options and choosing a plan that works for you and your family.

Here is TMA’s next “Hey, Doc” report:

Week of Nov. 18: What are the subsidies? Who gets a subsidy? How do I apply for a subsidy?

TMA is the largest state medical society in the nation, representing more than 47,000 physician and medical student members. It is located in Austin and has 112 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.

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Contact: Pam Udall
phone:(512) 370-1382
cell: (512) 413-6807

Pam Udall  

Contact: Brent Annear
phone: (512) 370-1381
cell: (512) 656-7320

Brent Annear  

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Check out MeAndMyDoctor.com for interesting and timely news on health care issues and policy. 


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