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Obamacare, also known as the Affordable Care Act (ACA), facilitated the creation of a health insurance marketplace. The plans offered in this marketplace vary widely based on several factors, including the company you purchase insurance from, the state you live in, and the plan you choose. However, how much does Obamacare cost?
The average monthly cost for a 30-year-old individual on an Obamacare ACA marketplace health insurance plan is $412. This number varies by age, plan, state, and eligibility for benefits and programs such as Medicaid, Premium Tax Credits, subsidies, and catastrophic health insurance.
Many factors affect the cost of Obamacare. Below, we will explain the most important factors and provide some insight into how you can save money on Obamacare.
Average Costs of Obamacare
The following Obamacare average costs don’t factor in the premium tax credits that a household may or may not qualify for. Instead, they represent how much the average person will pay towards their health insurance premium every month, regardless of subsidies.
| Health insurance plan members (sorted by age and family size) | The average monthly cost for an ACA (Obamacare) marketplace plan |
| Children aged 0-14 | $277 |
| Child aged 18 | $326 |
| An adult individual aged 21 | $365 |
| An adult individual aged 27 | $386 |
| An adult individual aged 30 | $412 |
| An adult individual aged 40 | $469 |
| An adult individual aged 50 | $655 |
| An adult individual aged 60 | $994 |
| Couple age 21 | $730 |
| Couple age 30 | $834 |
| Couple age 40 | $937 |
| Couple age 50 | $1,311 |
| Couple age 60 | $1,987 |
| Couple+1 child, age 21 | $1,007 |
| Couple+1 child, age 30 | $1,110 |
| Couple+1 child, age 40 | $1,214 |
| Couple+1 child, age 50 | $1,588 |
| Couple+2 children, age 21 | $1,284 |
| Couple+2 children, age 30 | $1,387 |
| Couple+2 children, age 40 | $1,491 |
| Couple+2 children, age 50 | $1,864 |
Obamacare Tiers
In the Obamacare marketplace, plans are separated into four separate tiers (not including Medicaid and catastrophic plans). These are as follows:
- Bronze-tier plans have lower deductibles, but lower levels of coverage.
- Silver-tier plans generally have mid-range costs, including a somewhat low deductible.
- Gold-tier plans have high monthly premiums but low deductibles, which means less is paid out of pocket.
- Platinum-tier plans have the highest monthly premiums out of all four tiers, but their deductibles are significantly lower. Care costs are also lower than in other tiers.
Here is a table that shows the distribution of payment between you and an insurance company plan offered under one of the four categories:
| Plan Tier | % of Healthcare Costs the Insurance Company Pays | % of Healthcare Costs You Pay |
| Bronze | 60% | 40% |
| Silver | 70% | 30% |
| Gold | 80% | 20% |
| Platinum | 90% | 10% |
The average lowest-cost bronze premium in the United States costs $342 per month. The average lowest-cost silver premium costs $448 per month. The average lowest-cost gold premium is $472 per month.
As you can see, the difference between the average lowest-cost bronze premium and the average lowest-cost gold premium in the United States is about $130 per month, which means that there is a significant difference in the monthly cost of Obamacare insurance plan tiers.
These plans vary significantly in coverage, but all of them are required to cover basic healthcare needs. Required coverage areas include:
- Preventative Care
- Emergency Care
- Hospitalization
- Rehabilitative Services
- Pregnancy and Newborn Care
- Outpatient Care
- Mental Health Services
- Substance Abuse Recovery
- Pediatric Care
- Laboratory Services
The following table shows the average monthly cost certain individuals and families might expect to pay for a bronze, silver, or gold Obamacare plan. Note that platinum-tier insurance is offered by very few companies, so it has been excluded from this table.
| Health Insurance Plan Member | Average Monthly Cost of Bronze Plan | Average Monthly Cost of Silver Plan | Average Monthly Cost of Gold Plan |
|---|---|---|---|
| Children aged 0-14 | $237 | $310 | $341 |
| Child age 18 | $279 | $365 | $401 |
| Adult individuals aged 21 | $313 | $410 | $450 |
| Adult individuals aged 27 | $330 | $433 | $476 |
| Adult individuals aged 30 | $356 | $468 | $514 |
| Adult individual age 40 | $401 | $526 | $578 |
| Adult individuals age 50 | $560 | $736 | $808 |
| An adult individual aged 60 | $850 | $1,115 | $1,225 |
| Couple age 21 | $625 | $819 | $900 |
| Couple age 30 | $713 | $936 | $1,028 |
| Couple age 40 | $801 | $1,052 | $1,156 |
| Couple age 50 | $1,121 | $1,471 | $1,616 |
| Couple age 60 | $1,700 | $2,230 | $2,450 |
| Couple+1 child, age 21 | $862 | $1,130 | $1,241 |
| Couple+1 child, age 30 | $950 | $1,246 | $1,369 |
| Couple+1 child, age 40 | $1,038 | $1,362 | $1,496 |
| Couple+1 child, age 50 | $1,358 | $1,782 | $1,957 |
| Couple+2 children, age 21 | $1,099 | $1,440 | $1,581 |
| Couple+2 children, age 30 | $1,186 | $1,557 | $1,710 |
| Couple+2 children, age 40 | $1,275 | $1,673 | $1,837 |
| Couple+2 children, age 50 | $1,594 | $2,092 | $2,298 |
The following table shows the average lowest-cost premiums for the first three tiers of healthcare plans offered under Obamacare, with averages for each state displayed separately. This may help give a clearer picture of what the cheapest plan you could find in the marketplace might cost in your state.
| Location | Average Lowest-Cost Bronze Premium | Average Lowest-Cost Silver Premium | Average Benchmark Premium | Average Lowest-Cost Gold Premium |
| Vermont | $641 | $837 | $841 | $894 |
| West Virginia | $627 | $822 | $824 | $839 |
| Wyoming | $573 | $801 | $802 | $708 |
| Alaska | $458 | $746 | $762 | $674 |
| New York | $484 | $619 | $627 | $799 |
| South Dakota | $459 | $608 | $626 | $626 |
| Connecticut | $515 | $592 | $627 | $577 |
| Alabama | $408 | $553 | $567 | $687 |
| Louisiana | $423 | $550 | $565 | $624 |
| Nebraska | $414 | $549 | $550 | $579 |
| Delaware | $403 | $542 | $549 | $528 |
| Oklahoma | $372 | $503 | $510 | $507 |
| North Carolina | $352 | $501 | $512 | $531 |
| South Carolina | $355 | $489 | $496 | $515 |
| Iowa | $346 | $475 | $484 | $451 |
| Missouri | $385 | $472 | $473 | $562 |
| Montana | $343 | $471 | $477 | $521 |
| Tennessee | $341 | $471 | $473 | $477 |
| Florida | $353 | $468 | $471 | $459 |
| Kansas | $353 | $467 | $471 | $480 |
| North Dakota | $296 | $463 | $475 | $452 |
| Mississippi | $401 | $462 | $461 | $548 |
| Utah | $331 | $462 | $471 | $545 |
| Texas | $324 | $454 | $461 | $407 |
| Oregon | $343 | $453 | $462 | $493 |
| Illinois | $340 | $449 | $453 | $482 |
| Maine | $372 | $449 | $457 | $507 |
| Wisconsin | $334 | $449 | $456 | $462 |
| New Jersey | $358 | $435 | $441 | $674 |
| Hawaii | $329 | $430 | $469 | $439 |
| New Mexico | $357 | $429 | $445 | $353 |
| District of Columbia | $396 | $426 | $428 | $495 |
| Pennsylvania | $292 | $420 | $433 | $380 |
| Kentucky | $333 | $417 | $422 | $472 |
| Idaho | $325 | $415 | $420 | $444 |
| Arkansas | $354 | $411 | $416 | $491 |
| California | $342 | $411 | $432 | $453 |
| Georgia | $328 | $411 | $413 | $433 |
| Ohio | $322 | $411 | $413 | $455 |
| Massachusetts | $347 | $407 | $417 | $522 |
| Arizona | $326 | $405 | $410 | $478 |
| Indiana | $327 | $395 | $397 | $521 |
| Nevada | $295 | $385 | $386 | $464 |
| Washington | $280 | $382 | $395 | $395 |
| Colorado | $291 | $376 | $380 | $363 |
| Rhode Island | $270 | $364 | $379 | $379 |
| Michigan | $266 | $354 | $362 | $398 |
| Virginia | $277 | $354 | $371 | $360 |
| Maryland | $242 | $334 | $336 | $323 |
| Minnesota | $287 | $328 | $335 | $376 |
| New Hampshire | $266 | $317 | $323 | $359 |
Out of Pocket Expenses
While all these averages are important to consider, they leave out a significant portion of the medical costs a person might be responsible for over a period of time: out-of-pocket expenses.
The average U.S. employee paid $1,669 out-of-pocket for medical expenses before they hit their deductible in 2021. Many people end up owing much more for serious injuries or remedies to chronic conditions. Of course, these costs vary so much that it is difficult to measure them accurately, but they are important to take into account when considering how much money you might have to pay for health insurance and medical costs.
Health Care Cost Factors
Exactly how much your Obamacare health insurance will cost varies depending on the following factors.
Benefit Design
Different insurance plans come with different benefit designs. The benefit design of the plan you choose may influence its price. The benefit designs typically look like one of the following:
- Health Maintenance Organization (HMO): Health maintenance organization (HMO) plans limit coverage to care from in-network doctors and hospitals. Specialists must be referred by an in-network doctor in order to be covered by their insurance. This type of plan won’t pay for out-of-network care except in the case of an emergency.
- Exclusive Provider Organization (EPO): Exclusive provider organization (EPO) plans limit coverage to in-network doctors, hospitals, and specialists.
- PPO Plans: PPO plans don’t require referrals and allow for out-of-network care to be provided. However, they are typically much more expensive than the other two plan types.
Age
Health insurance companies that offer Obamacare health insurance plans can charge the elderly higher premiums (due to the increase in medical costs that they will likely have to cover), but cannot charge more than three times the premium that they do for younger demographics.
Income
This is one of the biggest factors that will affect how much you will save on health insurance with Obamacare. If you make between 100% and 400% of the Federal Poverty Level (which currently is $18,755 for an individual, $25,268 for a two-person family, $31,782 for a three-person family, and $38,295 for a four-person family), you may qualify for a subsidy. In recent years, the 400% income cap has been waived, which means that some households making over 400% of the FPL may qualify for some premium tax credits.
One type of health insurance subsidy is premium tax credits. This type of subsidy is applied as an increase on a person’s tax return. For example, if they had to pay $5,000 in federal taxes for a certain year and qualified for a premium tax credit of $2,000 that same year, they would receive $2,000 back in on their tax return. The following is a chart of the eligibility of people for premium tax returns in 2017, as per IRS.gov. The current values may be slightly different.
| Household Size | 100% of FPL | …up to… | 400% of FPL |
| Individual | $11,880 | $47,520 | |
| Family of 2 | $16,020 | $64,080 | |
| Family of 4 | $24,300 | $97,200 |
Cost sharing reduction (CSR) is a type of discount that lowers the amount of money that you have to pay for copayments, deductibles, and coinsurance. While premium tax credits apply no matter which tier of plan you choose, CSR discounts only apply if you choose a silver plan.
An additional benefit of qualifying for cost-sharing reduction discounts is a lower out-of-pocket maximum (the total amount you will have to pay out of pocket in a year before insurance pays for everything). Federally recognized Native American tribe members may qualify for additional cost-sharing reductions.
Location
As is evidenced in the above table that compares the average-lowest costs per state, location can measurably alter the amount you pay per month for an Obamacare insurance plan.
Tobacco Usage
Insurance companies are allowed to charge people as much as 50% more if they are tobacco users. This is because of the health issues that tobacco products can cause.
Medicaid
In addition to several other measures intended to reduce healthcare costs for Americans, Obamacare also attempted to increase Medicaid coverage. Some states did end up expanding their Medicaid coverage, while some did not. The chart here lists which states did and did not expand their coverage.
In some states, you can qualify for Medicaid if your income is between 100% and 138% of the federal poverty line. In other states, you must be under the federal poverty line to qualify for Medicaid. In the majority of cases, those who qualify for Medicaid will likely save more by applying for it instead of for a standard plan from the normal tiers. Note that if this is the case, you will not be eligible for any other type of subsidy.
Catastrophic Health Plans
Those who are under 30 years old and those who are 30 years old or older and have a hardship or affordability exemption can purchase a catastrophic health plan. These plans have low premiums and very high deductibles. These plans may be helpful if you end up getting seriously sick or injured, as after you pay the deductible, there is no copayment or coinsurance, as the insurance company pays the rest in full.
However, they require you to pay out of pocket for nearly every medical expense except 3 primary care visits and a few preventive services, which can become very expensive if you need additional care. Catastrophic plans disqualify you from using premium tax credits to reduce healthcare costs.
Now that you know how much Obamacare costs, determine which plan is best for you and your family.
Alternative to Health Insurance
When it comes to your healthcare, most people think that their only options are to pay for expensive Health Insurance or try out your luck being uninsured.
The great news is that you have a third option; You can join a Health Share plan that is affordable and meets your needs! Health Sharing programs are one of the most effective and affordable alternatives to Health Insurance.
If you don’t know what a Health Share is, you can start here to learn how it works and why it’s a great alternative to health insurance. If you are looking for affordable healthcare, I highly recommend checking out my article about the Best Health Share Plans.
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