How Choosing the Wrong Health Insurance Coverage Could Cost You $1,538

The average consumer has 30-40 health plans available so you might need to evaluate dozens of plans to find the right one.

#yourhealthplan should:

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Protect your health
and quality of life

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Provide access to doctors, hospitals, treatment and prescriptions

Aside from your health, #yourhealthplan should protect your wallet.

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ImageCONSUMER PROFILES

Let's look at 3 people with different healthcare needs

ImagePlans

Consumers need an insurance plan that works for them, based on their use of healthcare.

Each of the three plans below has unique costs.

Bronze Silver Gold
Monthly PremiumCloseDetails
$244 $297 $348

Let’s break this down even further.

Here is what each person would have spent on 3 different health plans.*

Hover over the bars to see how well each plan fits each consumer’s needs.

ImageOptimal Plan
  • $10k
  • $9k
  • $8k
  • $7k
  • $6k
  • $5k
  • $4k
  • $3k
  • $2k
  • $1k
  • $0
LARRYHealthy
  • $10k
  • $9k
  • $8k
  • $7k
  • $6k
  • $5k
  • $4k
  • $3k
  • $2k
  • $1k
  • $0
STEPHANIEType 2 Diabetes
  • $10k
  • $9k
  • $8k
  • $7k
  • $6k
  • $5k
  • $4k
  • $3k
  • $2k
  • $1k
  • $0
BENMultiple Conditions
Close

Bronze

Larry is very healthy and uses little medical care beyond preventive care. For the year on the bronze plan, Larry would pay:

Image Premium $2,928
Image Medical
& Drug
$161
Total $3,089

Choosing a lower-premium bronze plan is perfect for Larry because he doesn’t need the greater coverage of a higher-premium plan.

Close

SILVER

Larry is very healthy and uses very little medical care beyond preventive care. For the year on the silver plan, Larry would pay:

Image Premium $3,564
Image Medical
& Drug
$130
Total $3,694

Larry doesn’t need the greater coverage of the higher-premium silver plan. Knowing his healthcare needs, he would overspend by $605, mostly for higher premiums on coverage he does not need.

Close

GOLD

Larry is very healthy and uses very little medical care beyond preventive care. For the year on the gold plan, Larry would pay:

Image Premium $4,176
Image Medical
& Drug
$10
Total $4,186

Larry doesn’t need the greater coverage of the higher-premium gold plan. Knowing his healthcare needs, he would overspend by $1,097, mostly for higher premiums on coverage he does not need.

Close

Bronze

Stephanie has a chronic condition that requires ongoing medication and specialist visits in addition to preventive care. For the year on the bronze plan, Stephanie would pay:

Image Premium $2,928
Image Medical
& Drug
$2,498
Total $5,426

Low premium doesn’t always mean low cost, because the high deductible forces Stephanie to pay the full price of most of her care. If she chooses this plan, she overspends by $312.

Close

SILVER

Stephanie has a chronic condition that requires ongoing medication and specialist visits in addition to preventive care. For the year on the silver plan, Stephanie would pay:

Image Premium $3,564
Image Medical
& Drug
$1,550
Total $5,114

Low premium doesn’t always mean low cost, and the silver plan’s relatively low deductible makes it the perfect plan for Stephanie.

Close

GOLD

Stephanie has a chronic condition that requires ongoing medication and specialist visits in addition to preventive care. For the year on the gold plan, Stephanie would pay:

Image Premium $4,176
Image Medical
& Drug
$972
Total $5,148

The low deductible on the gold plan makes this almost the perfect plan for Stephanie. However, If she chooses this plan, she overspends by $34.

Close

Bronze

Ben has multiple chronic conditions that require ongoing medication, specialist visits, ER visits and hospital stays in addition to preventive care. For the year on the bronze plan, Ben would pay:

Image Premium $2,928
Image Medical
& Drug
$7,150
Total $10,078

Low premium doesn’t always mean low cost, making the bronze plan a poor fit for Ben. Although he hit his OOP maximum, he could get a lower OOP max on the gold plan. If he chooses this plan, he overspends by $902.

Close

SILVER

Ben has multiple chronic conditions that require ongoing medication, specialist visits, ER visits and hospital stays in addition to preventive care. For the year on the silver plan, Ben would pay:

Image Premium $3,564
Image Medical
& Drug
$7,150
Total $10,714

The silver plan is a poor choice for Ben. Although he would hit his out-of-pocket maximum, he could get a lower OOP max on the gold plan. If he chooses this plan, he overspends by $1,538.

Close

GOLD

Ben has multiple chronic conditions that require ongoing medication, specialist visits, ER visits and hospital stays in addition to preventive care. For the year on the gold plan, Ben would pay:

Image Premium $4,176
Image Medical
& Drug
$5,000
Total $9,176

High premium doesn’t always mean high cost, and the gold plan is perfect for Ben. The low OOP costs and OOP maximum more than compensate for the higher premium.


* There are no Platinum plans available in this particular zip code, reflecting the limited availability of such plans
throughout the country. It is likely that a Platinum plan would best suit Ben if one were available.

ImageTHE BOTTOM LINE

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Even 10 minutes of comparison shopping could save you $1,000.
— @JeffSmedsrud, Co-founder of HealthCare.com

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