The Definitive Guide to Health Insurance

By LoweredRates.com

Staying healthy is one of the most important things that any individual can do, as your health can dramatically affect your quality of life, your life expectancy, and much more. Healthcare is one of the biggest industries worldwide, and the US spent 3.5 trillion dollars on it in 2017 alone.

Since healthcare can get so expensive, many people decide to invest in health insurance so they can rest assured that their medical bills will be paid in the event of a health crisis. Health insurance is one of the more complicated types of insurance, and people who aren’t acquainted with the details and terminology may feel a little intimidated.

This guide has been written to act as a one-stop resource for all relevant health insurance info in the USA. It will cover the basics of health insurance, relevant terms, ways to minimize premiums, and even a guide covering health insurance details in 50 different states.

group of doctors

What is a Health Insurance Policy?

A health insurance policy is an agreement where an insurer agrees to cover medical expenses for a policyholder. This service is provided in return for a fee (known as a premium) that is paid either monthly or annually. Details about the types of medical expenses covered depend on the policy itself.

Some health insurance policies will mandate that you only see a specific physician or stay within a certain network. Other forms of health insurance may only cover medical procedures of a certain type. As with all forms of insurance, much is dependent on the individual policy.

Why Do People Buy Health Insurance?

There are many reasons why someone would choose to invest in health insurance, and they may vary from person to person. Many customers prefer to be covered by health insurance instead of potentially having to pay for medical procedures out of their pockets.

Insurance can also give policyholders some peace of mind, as they won’t have to deal with potential bankruptcy if they have to undergo an expensive procedure in the hospital.

Some policyholders don’t buy health insurance themselves, but they may be covered by a corporate policy as a work benefit.

Health insurance can also open up avenues of treatment that may have previously been restricted due to their cost. Instead of having to settle for a cheaper treatment, your health insurance may allow you to pick a procedure that offers a higher chance of success or less of an impact on your quality of life.

In the end, people buy health insurance because of the fundamental importance of staying in good health. Being healthy ensures that you can enjoy your life to the fullest.

How Has Health Insurance Changed Over the Years?

As with auto insurance, Massachusetts played a significant role in the development of health insurance in the United States. Massachusetts’ Franklin Health Assurance Company was the first to offer accident insurance, and they were founded back in 1850. Most of these early plans were designed to cover loss of income due to an accident instead of the treatments themselves.

It took until the 1920s when hospitals started offering their own prepayment programs, a system which eventually evolved into the Blue Cross. Employer health insurance originated in WWII, as wages were strictly controlled, and companies used additional benefits to attract workers.

Until the 1960s, private health insurance was relatively unpopular among Americans due to its high cost, and most who were covered got their insurance through their employer. This led to the creation of public health insurance programs for people who were either ineligible for private insurance or couldn’t afford it.

This included the passing of the Kerr-Mills Act and the subsequent development of state risk pools. These risk pools offered guaranteed insurance to customers who were too much of a risk for private insurers, though the rates and the deductibles were higher.

Throughout the second half of the 20th century, there were several attempts to implement a form of universal healthcare in the United States, but they never fully succeeded.

healthcare application

Types of Health Insurance

There are many different kinds of health insurance plans, and they offer varying rates and degrees of freedom to pick your physician. Many health insurance plans operate within a certain network of healthcare providers, meaning that they will only cover treatment if a doctor is part of that network.

Health Maintenance Organization (HMO)

Health Maintenance Organization insurance plans are typically some of the most affordable, but they’re also far more restrictive than other kinds of health insurance. Many HMOs require the policyholder to select a primary care physician (PCP), and that doctor will be their only option unless they are referred to a specialist.

HMOs offer more affordable premiums, and they also reduce the money that policyholders have to pay out of their pocket for treatment. Copayments are the most common out of pocket expenses for HMO insurance, but policies may also have deductibles that have to be paid before coverage.

Another thing to keep in mind about HMOs is that they will usually cover preventative care like checkups, flu shots, and more. You also won’t have to file claim paperwork every time you need to be covered by an HMO plan.

Keep in mind that you will not be covered if you seek treatment outside of your network with an HMO. The only exceptions are when explicitly authorized by the primary care physician.

Preferred Provider Organization (PPO)

Preferred Provider Organization health insurance is a little more lenient than an HMO plan, as it doesn’t require the policyholder to designate a primary care physician. Instead, the plan will cover healthcare services from any of the doctors within its network.

This network can include both doctors and specific hospitals, and the size of the network will depend on the plan and the insurance provider. This kind of health insurance has some of the highest premiums, as it offers the client a large degree of freedom when picking through treatment options.

PPO insurance typically includes a deductible that clients will have to pay before the insurer covers the rest of their expenses. Copay and coinsurance are also relatively common in PPO plans, and they’re typically charged as a percentage of the overall expenses incurred.

Unlike HMO plans, clients with a PPO won’t have to seek a written referral to see a specialist. PPOs also differ from HMOs in that your expenses will be covered outside of your network, but the treatment will be more expensive. Out-of-network claims will require the submission of claim paperwork.

To sum it up, a PPO plan balances costs and flexibility, as it doesn’t require a PCP, yet it still restricts you to a network.

Exclusive Provider Organization (EPO)

An Exclusive Provider Organization policy occupies the middle ground between an HMO and a PPO, as it blends elements of both of them. Like an HMO, an EPO requires that you stay within its network if you want it to cover your treatment. Another similarity to HMO coverage is that EPOs don’t require you to submit claim paperwork.

Where the differences start is that the EPO doesn’t require you to select a PCP, allowing you to frequent any doctor that is within the network. Another difference is that an EPO won’t require you to seek a referral before you go and see a specialist.

Premiums for this kind of health insurance are relatively affordable, though they’ll still be higher than those for an HMO plan. Most EPO plans also have a deductible, so you will need to pay for a portion of the treatment out of pocket before you can expect to be covered.

Point-of-service Plan (POS)

POS plans take elements of both HMO and PPO plans and combine them. One of the defining characteristics of the POS plan is the inclusion of a PCP. When being treated by the primary care physician, clients on a POS plan typically won’t have to pay a deductible before they are covered.

Where the POS plan differs from the HMO is in the ability to receive treatment from outside of your network. While out-of-network treatment will still be covered by a POS, it will be subject to a deductible and may be held to lower limits than if you were making a claim through your PCP.

When it comes to premiums, POS plans tend to be more affordable than PPO plans, though they are more expensive than HMO coverage. This makes them an attractive compromise for customers who desire the flexibility of a PPO but are unwilling or unable to deal with the elevated premiums.

When visiting a non-network provider, a POS plan may also require you to pay for the procedure out of your pocket before being reimbursed at a later date.

High-deductible Health Plans (HDHP) and Health Savings Accounts (HSA)

High-deductible Health Plans work together with Health Savings Accounts to create an alternative form of coverage. With an HDHP, the policyholder will have to pay a higher deductible before medical expenses are covered (a minimum of $1400 for individuals).

This is a kind of catastrophic health insurance, as most minor procedures will be below the deductible. This reduces the frequency of health insurance claims, but it will leave the client on the hook for more expenses.

HDHPs work alongside HSAs to ensure that you have enough money for eventual healthcare. An HSA is a tax-advantaged savings account that you can only use for medical expenses. This can help cover the higher cost of deductibles as well as any other expenses incurred by your treatment.

The limit to annual out of pocket expenses for an HDHP is $6900 for an individual. Keep in mind that this limit is only for in-network services.

Travel Health Insurance

Most health insurance policies will provide few if any benefits to policyholders when they leave the borders of their home countries. In these cases, travel health insurance exists to cover them while they are abroad.

Due to its nature, travel health insurance won’t cover checkups, prescriptions, or treatments for pre-existing conditions. It will typically only apply to emergency medical care in other countries, as well as many of the costs associated with it.

Medical evacuation coverage is one of the main selling points of travel health insurance. This kind of insurance will pay for your expenses if you need to be medevaced from a remote area or if you need to travel to a distant hospital to get the kind of treatment you require.

Some kinds of travel insurance will also include coverage for unforeseen events, including terror attacks, natural disasters, or civil upheaval.

Before opting for travel insurance, make sure that you aren’t already covered for out-of-country medical expenses by your domestic health insurance policy. While it is rare that domestic policies cover you while traveling, some comprehensive plans may cover certain expenses while abroad.

Is Health Insurance Mandatory?

The Affordable Care Act (ACA), which was also known as Obamacare, created tax penalties for Americans without a healthcare policy. If you didn’t have an exemption, then you would have to pay a penalty when filing your taxes, almost making health insurance coverage mandatory.

In 2019, the tax penalties for the Affordable Care Act were dropped, though the act itself is still in place. This means that health insurance is no longer required for Americans who don’t want to pay a penalty on their taxes.

However, despite the elimination of the penalties for the ACA, there are some states that still require health insurance so their residents don’t get penalized.

California, Massachusetts, New Jersey, and Vermont each have some form of law requiring their residents to have health insurance. Though not a state, Washington D.C. also has mandatory health insurance.

Some states have attempted or are currently attempting to create a law for mandatory health insurance, including Connecticut, Maryland, Rhode Island, and Hawaii.

In most states, health insurance is not mandatory, and it is up to the individual to decide if it’s necessary if they don’t have a health insurance policy through work.

Why the Cheapest Health Insurance Can Get Costly in the Long Run

When looking at health insurance premiums, the more affordable options with lower premiums can often be an attractive choice. However, many customers don’t realize that they can often end up paying more by opting for a cheaper health insurance plan, as there are some unexpected benefits to pricier coverage.

Many affordable health insurance plans will typically cover a portion of the medical expenses, leaving you responsible for the rest. The percentage of your plan that you’re responsible for will include copay, coinsurance, and deductibles.

When picking a health insurance policy, you can pick one of two types of plans.

The first variety will have a high monthly rate but will minimize your potential out of pocket expenses when you have to visit the doctor or you require some form of medical treatment.

On the other hand, you can opt for a more affordable health insurance plan with low monthly rates but much higher out of pocket expenses. When you get a plan like this, you’re essentially gambling the money you save on your insurance premium on the possibility that you won’t get sick.

If you do end up getting sick, then you may have to pay a lot more out of pocket than you would have spent on insurance premiums. On the other hand, you can pay for health insurance your whole life and never have a bad enough injury for it to pay off. As always, the decision is yours to make (preferably after sufficient research and consideration).

insurance form

Common Health Insurance Terms

This section will serve as a bit of a glossary for the article, as there is plenty of jargon used in health insurance. While all kinds of insurance use specific words, health insurance uses a blend of insurance and medical terminology, making it particularly difficult for outsiders to understand.

Deductible

In insurance, a deductible is the amount that the policyholder has to pay before the insurer will cover their part of the expenses. Keep in mind that the insurer may still not pay all expenses after the client has covered the deductible, as copay and coinsurance may still leave the policyholder responsible for some expenses.

To give you an example, a plan with a $500 deductible will require the client to pay $500 out of pocket before the insurance company starts covering their end of the arrangement. As was mentioned before, deductibles are directly linked to the monthly premium for your insurance policy.

Policies with higher premiums will feature a lower deductible, and policies with a high deductible will have more affordable premiums. This is because a higher deductible reduces the likelihood of a policyholder making a claim, as it doesn’t make sense to file a claim for anything below the threshold of the deductible.

Exclusion

Exclusions are exceptions that are written into the insurance agreement. These include situations in which the insurer is not responsible for medical costs when discussing health insurance.

Most health insurance policies come with a list of exclusions, and one of the most common ones is the exclusion for elective and cosmetic surgeries. Procedures like rhinoplasty and liposuction are almost never covered by a health insurance policy, as they aren’t rooted in an essential health issue.

Each policy will have its own list of exclusions, and it’s highly recommended that clients read through them carefully before deciding on the policy they want.

Premium

Your insurance premium is the rate that you pay for insurance. Premiums can either be defined in monthly or annual terms, and most private health insurance clients choose to pay off their premiums on a monthly basis, though some providers offer incentives for paying annually.

Coinsurance

Coinsurance is a distinct feature of health insurance, and the concept is similar to a deductible, though there are some key differences between the two. Much like a deductible, coinsurance is a cost that comes out of the policyholder’s pocket, though the coinsurance applies after the deductible has been paid.

While the deductible is the amount that you need to pay so that the insurer will take up their end of the deal, coinsurance is the part of the medical bill that you owe, expressed in a percentage. The percentage that the client is responsible for will typically range from 10% to 40% of the total bill.

The amount of coinsurance that you’re responsible for is determined by the rate that you pay for health insurance, and it’s closely linked to the concept of copay.

Copayment

Copayment (or copay) is similar to coinsurance in that it’s a cost that you’re responsible for. While coinsurance is expressed as a percentage of the overall cost of the procedure, your copay is a fixed fee that you have to pay every time your insurance coverage kicks in.

For example, you may have to pay a flat fee every time you purchase prescription drugs using your medical insurance policy.

Benefit Period

The benefit period is the amount of time that you are covered by the insurance agreement. Nearly every health insurance policy has a benefit period of one year long, though this may not be the case for specialized policies like travel insurance.

To ensure that benefits continue uninterrupted from one benefit period to the other, the policyholder will have to renew their health insurance before the previous period elapses.

Most benefit periods will begin after the first payment is made by the policyholder, but there are some kinds of health insurance that will require an elimination period (time before the benefit period begins). This is a common feature of long-term disability policies.

Pre-existing Condition

There are two definitions for pre-existing conditions. The first defines it as a condition that was diagnosed and treated by a medical professional before the plan went into effect. While this definition makes sense, it doesn’t account for existing conditions that haven’t been diagnosed.

The second definition states that a pre-existing condition is one that exhibited symptoms that a “prudent person” would have sought medical care for before the plan came into effect. This definition is harder to quantify, as symptoms aren’t always outwardly apparent.

Emergency Medical Condition

Some health insurance plans have exceptions or rules in place for treatment of emergency medical conditions, such as waiving the penalties for seeking treatment outside of your network. While most people would recognize an emergency medical condition, what actually constitutes one?

An emergency medical condition is one that manifests itself through severe symptoms or pain. This may result in the impairment of the body’s operation, risk of organ failure, or put the individual’s health at serious risk.

Inpatient Services

Inpatient services are healthcare services rendered to an individual while they are occupying a room at a hospital and responsible for room and board. They are the opposite of outpatient services, which are medical procedures rendered when an individual is not staying at a hospital.

Insurance policies make the distinction between these two kinds of services because they may pay out differently for each of them. Inpatient services tend to be expensive, and cheaper plans may minimize the amount that they pay out for them.

Network Provider

A network provider is a healthcare provider that operates within a certain network. These networks will typically work with certain insurance companies, offering discounted services to the people that they cover in exchange for the additional business that insurers bring them.

A network provider can either be a doctor or a healthcare establishment like a hospital. Depending on your insurance plan, you may have to pay extra for an out-of-network provider, or it may not be covered by your insurance at all.

Out of Pocket Costs

Out of pocket costs are expenses that are not covered by insurance. They come directly out of the policyholder’s pocket, hence the term. Deductions and coinsurance are both types of out of pocket expenses.

Due to the prevalence of copay and coinsurance alongside deductibles, health insurance tends to have higher out of pocket costs when compared to other types like auto and home insurance.

seniors happy with coverage

Private vs. Public Health Insurance

While private health insurance makes up the majority of health insurance in America, unlike many other western countries, public insurance still has a larger presence than many give it credit for. About 26% of Americans are covered by a public health insurance policy, and this part will explore the differences between public and private health insurance.

Private Health Insurance

This is the kind of health insurance that the majority of the American population has, and it is funded entirely by the individual or by private entities like their employers. Since America doesn’t have universal healthcare, it is one of the few first world countries in which the majority of the population has private health insurance.

Private insurance has a few advantages over public insurance, mainly in the amount of choice the policyholder has in deciding their coverage. Depending on how much you’re willing to spend on your health insurance premiums, you can customize your policy so that it fulfills your needs.

The disadvantage of private health insurance is that it is often far more expensive than public insurance programs. It also leaves the decision up to the individual, provided insurance isn’t mandated by the place that they live in.

Public Health Insurance

Public health insurance in America is available in three forms: Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).

Medicare

Medicare mainly exists to care for the elderly (over 65) population of the United States, as they are typically no longer working and may not be able to afford private insurance. Medicare is funded entirely by the federal government.

Due to the rising number of elderly people in America, Medicare costs are rising higher by the year. One of the goals of the Affordable Care Act was to reduce the number of people using Medicare because of poverty and instead expanded the capabilities of the Medicaid system.

Medicaid

Medicaid is another form of public health insurance that exists to make it easier for the economically disadvantaged to get coverage. Unlike Medicare, Medicaid is funded by the federal government and the states, and its implementation varies from state to state.

The Affordable Care Act made it so that families who make less than 133% of poverty-level income and do not qualify for Medicare are instantly eligible for Medicaid.

CHIP

The Children’s Health Insurance Program exists to catch any children in poverty-stricken families who have not qualified for Medicaid. It is only available if the family has not qualified for Medicaid or Medicare and does not have sufficient money to purchase private coverage.

How Are Health Insurance Premiums Priced?

There are many factors that go into determining how much a customer can expect to pay for their health insurance policy. Your premium will depend on a range of factors, some of which are in your control and others that are out of it.

The following section will be split into two sub-categories based on the kind of factor: personal or environmental. The most significant factors are typically personal but don’t underestimate the effect that the area you live in can have on your insurance premiums.

Personal Factors

The factors in the following section will be related to you and your body, including your current level of health, your age, and more.

Age

Age is one of the single most significant contributors to health insurance cost because the risk of medical conditions increases as you get older. As your body ages, your body becomes less effective at repairing damage and may be suffering from years of wear and tear, increasing the chance of a medical issue arising.

Keep in mind that this is only a general guideline, as some fifty year-olds may be healthier than people half their age. However, since the insurance company doesn’t know you or your lifestyle, they can’t assume that all of the older applicants they’re getting are living perfectly healthy lives.

Typically, health insurance premiums will be higher for older clients and more affordable for younger policyholders.

Smoking

Smoking is another hugely significant factor in determining your health insurance rates, and it’s one of the few that is directly under your control. While curbing an addiction is never as simple as it may sound, attempting to do so and sticking with it can help immensely reduce your insurance premiums.

The reason for the rate increases related to smoking is due to all of the medical conditions that are associated with it. Of course, the best-known risk of smoking is lung cancer, but there are many other severe conditions associated with cigarettes, including heart attacks, strokes, and other forms of cancer.

Because of the elevated risk of these conditions, the insurance company sees itself as more likely to have to pay out when providing a policy to a smoker.

Family or Individual Policy

Whether you are covered individually or as a family may also affect your health insurance premiums. Most family health insurance plans will feature more affordable rates compared to the equivalent cost of individual policies for each family member.

Some insurers will only charge a premium for up to three children under the age of 21. This means that you’ll only have to pay a premium for your three oldest children, essentially getting your youngest free coverage.

Another thing to consider is the cost of deductibles and the out of pocket maximum for a term. In most family insurance policies, both of these are multiplied by a factor of two compared to an individual policy. This results in higher out of pocket costs compared to an individual policy.

Medical History

Your medical records will also heavily influence your health insurance rates, as they will let the insurer know just how frequently you visit the doctor. This will give them an idea of how much they’ll spend on you while you’re covered. Regular checkups can also positively affect your rate, as they prove that you’re intent on staying healthy.

Going through your medical history also allows an insurer to determine if you have any existing conditions that they should be aware of, but you should always declare these yourself. These existing conditions can result in problems that appear later on, and the insurance company will adjust your rates accordingly.

Some insurers may even consider a client too much of a risk to work with after going over their medical history, and they may deny you a policy altogether, directing you towards high-risk insurance.

Physical Fitness

Your physical fitness is another aspect that you have some degree of control over, and it can also influence how much you pay for your health insurance. Staying in good shape dramatically reduces the risk of heart disease and other medical conditions that can end up being pricey for the insurance company.

Many insurers offer direct incentives to stay in good shape, offering discounts for customers who can prove that they exercise regularly. During your preliminary medical exam, your fitness and endurance may even be tested by the physician conducting the test.

Some insurance companies will even pay your annual gym fees to ensure that you remain fit, and others will offer rewards for following their weight loss programs.

Coinsurance and Deductible

Your insurance rates will also depend on the out of pocket costs associated with your plan. Health insurance plans with high out of pocket costs will have lower rates, though the policyholder is taking a greater risk, as they will have to pay more themselves if something goes wrong.

This forms the basis for the metal tiers that are used to categorize health insurance policies and compare their rates to the potential out of pocket costs. This guide will take a closer look at the metal tiers later on.

Environmental Factors

Along with factors related to you, where you live will also influence your health insurance costs, including the state you live in, your county, and your city.

Proximity to a Healthcare Facility

One of the main environmental considerations is the distance between where you live and the nearest healthcare facility. If you live right next to a big hospital in the city, then it’s unlikely that you’ll ever need to go far, even if you require specialist help.

On the other hand, if you live in a rural area far from any large hospitals, you may have to be transported far to see a specialist if you have a specific problem. This will result in additional costs for your insurer, increasing the risk that they’re shouldering by insuring you.

Distant healthcare facilities can also increase the severity of an injury, as bad injuries can get worse if you don’t receive immediate medical attention. For example, a hemorrhage can result in much more severe damage to your body and organs if the blood loss isn’t stopped soon enough.

The State or County That You Live In

The state that you live in will be the primary geographical factor that affects your health insurance rate because every state sets its own limits that insurers can charge. However, to make insurance rates more granular, states are divided into geographic rating areas.

These areas can be as small as a single county or encompass several of them, and they’re meant to give insurance companies a better idea of factors that can influence the frequency of claims. Many of the factors that have been included in this section will go into determining the rating for a specific area, including pollution, poverty, and more.

Pollution

Pollution is a major factor that can affect your long-term health, as it increases the risk of respiratory illness. In turn, this increases the risk that an insurance company is taking by giving you a policy, so areas with higher pollution will typically be part of a more expensive geographic rating area.

Pollution is one of the factors that go into making health insurance in cities more expensive.

Socio-economic Circumstances

The relative prosperity of a region can also affect how much you pay for health insurance. If you live in a poor area, then you may not have access to the kind of care facilities that you may require in an emergency. Insurance companies also assume that people in poorer neighborhoods visit the doctor less regularly and are exposed to less healthy conditions.

The wealth of a region is another aspect that is factored into a geographic rating area to determine the premium limits imposed by the state in that zone.

Altitude

Higher altitudes increase blood pressure and increase the risk of certain respiratory illnesses. Living at a higher altitude may slightly increase your insurance rates, though it will have to be significantly higher than sea level for it to meaningfully affect your health.

Temperature

Higher temperatures can increase the risk of heatstroke, particularly in younger children and the elderly. This can result in costly medical expenses, and the insurance company sees this as a more significant risk. Keep in mind that only extreme temperatures will drastically alter your insurance premium.

Colder areas can also be subject to more expensive health insurance rates since they will likely see snow and ice at some point in the year. The presence of ice greatly increases the risk of broken bones, contusions, and other injuries caused by slipping and falling.

lady in wheelchair insured

Health Insurance Metal Tiers

Health insurance plans are often grouped into four tiers to compare the amount that you pay for your premium and out of your pocket when you require medical care.

Bronze features the lowest monthly premium, but you will have to pay a significant deductible, and you may be responsible for a larger proportion of the care. On the other hand, a platinum plan will have the costliest rates, but the deductible will be low, and so will your out of pocket costs.

Bronze

The Bronze tier is meant for healthy customers who don’t expect to file many claims through their insurance and want it just in case of an emergency. The out of pocket costs in a bronze plan will typically be about 40% of the overall care, so you’ll have to pay for a significant chunk of the care yourself.

To offset the higher out of pocket costs, the bronze tier is the most affordable form of health insurance when looking at the premium. If you don’t expect to get injured and you don’t participate in risky activities, you may be drawn to a bronze plan by the potential savings on the premium.

Silver

Silver is one of the most common health insurance tiers, and it typically means that you’re responsible for 30% of the overall costs out of pocket. This kind of insurance has higher premiums than bronze, but it features lower copay and a smaller deductible to make up for it.

Silver plans are typically recommended for individuals with one or two slight conditions that may require light treatment. Anything beyond that may begin costing you more than you save on the lower premium because of frequent visits to the doctor and a higher deductible than a bronze plan.

Gold

The gold tier will typically require you to pay for about 20% of your medical care out of pocket, but this is offset by premiums that are only beaten by the platinum tier. Gold tier health insurance is often recommended for clients who are older or who have pre-existing chronic conditions.

If your medication is pricey or you require specialty medical care, the lower out of pocket costs of gold can help make up for the extra money you spend on the premium every month. Gold coverage is also ideal for families with younger children who frequently get pediatric care.

Platinum

Platinum health insurance has the lowest out of pocket costs, coming out to about 10% of the overall cost of the procedure. The deductible is also much smaller with a platinum plan, making it nearly negligible when compared to the other metal tiers.

This kind of health insurance is only recommended for individuals with severe medical conditions that require frequent visits to the doctor and result in pricey care and procedures. Platinum is also ideal for individuals who frequently require emergency care.

Consider Your Lifestyle When Picking Your Health Insurance Policy

There is no single best life insurance policy, as everyone has a different budget and varying healthcare needs. This section will cover three theoretical people with varying needs, and it will give you an idea of what kind of health insurance they opt for and how much they pay for it.

Andrew

Andrew is 21 years old and currently studying English in college. He doesn’t have much monthly income, but he keeps a significant emergency fund just in case. Andrew is also in perfect health, only ever visiting the doctor for his regular checkups.

Andrew’s Health Insurance

Andrew opts for bronze tier coverage with a 60/40 split because of how infrequently he requires healthcare. By saving on his monthly premium, he can contribute more money to his emergency fund to ensure that he can pay for his end of the expenses if he ever gets injured or falls ill.

How Much Does Andrew Pay?

$330 per month, $3960 per year

Clara

Clara is 30 years old, and she works as an HR manager for a moderately-sized company in her home city. Clara suffers from asthma, and she has to pay for her prescription drugs as well as regular doctor visits every year.

Clara’s Health Insurance

Since Clara’s asthma isn’t too severe, and she only needs two or three extra doctor visits per year along with her asthma pumps, she opts for silver coverage with a 70/30 split. This kind of health insurance plan gives Clara a moderate rate without making her out of pocket costs too expensive.

How Much Does Clara Pay?

$450 per month, $5400 per year

Terrence

Terrence is 70 years old, and his sedentary lifestyle has degraded his physical fitness over time. Being retired, he no longer needs to go to work and doesn’t move around very much. He suffers from diabetes, high blood pressure, and Hepatitis C that he contracted on his last vacation. Luckily, Terrence has a lot of money saved up from his time as a real estate agent.

Terrence’s Health Insurance

Terrence opts for gold coverage, meaning that he only has to pay about 20% of his healthcare bills after his deductible has been covered, with the insurance company covering the other 80%. That deductible is also much lower, but he pays a little more per month compared to other health insurance plans.

How Much Does Terrence Pay?

$520 per month, $6240 per year

pulse of family

Health Insurance Companies

There are two kinds of insurance companies: local and national. The differences between local health insurance companies and national health insurance companies come down to customer service, rates, and quality of service.

Local Health Insurance Companies

Local health insurance companies are the smaller of the two options, and they typically only operate within a smaller area like a state. One of the main reasons why clients prefer local insurance companies is because they can offer much more personalized service.

Since local health insurance companies have fewer clients than national carriers, you’ll find it much easier to get into a one-on-one conversation with an agent. This makes it easier to ask questions, express your concerns, or otherwise learn more about your policy from a human being as opposed to an FAQ section or a chat bot.

Another advantage to local companies is that they typically offer superior rates when compared to national insurance carriers. This can save you a crucial bit of extra money on your health insurance premium without having to reduce your level of coverage.

However, local insurance companies have a few disadvantages that hold them back from being the perfect choice. Their relative lack of resources means that they may not have as much of an online presence as their larger counterparts who operate nationwide.

National Health Insurance Companies

National health insurance companies can be a little more expensive than their local counterparts, but this may not always be the case. In some states, national insurers beat the smaller companies with their rates, and you still get the full range of advantages they offer over those other companies.

Since national health insurance companies have so many customers, they have additional revenue that they can invest in their systems. They will often have full-fledged knowledge databases where their clients can go to learn more about their policy or answer FAQs.

Another advantage to national insurers is that they will often have their own apps or a more advanced website that provides you with more functionality. This means that you don’t have to call or send an email to your insurance provider every time you want to see something about your policy.

Finally, national insurance companies will often have a 24-hour helpline that you can contact to get issues sorted out. This is rare for local insurance companies, as they typically don’t have the income to justify such comprehensive customer service.

Insurance Company Ratings (AM Best System)

The AM Best rating system for insurance companies isn’t a single system, but a set of different ratings compiled to show the performance of insurers in different areas. The most popular system is the FSR (Financial Strength Rating), which defines how well an insurer can withstand economic shifts and fulfill their obligations.

Companies that are higher on the scale are more financially stable and, therefore, less likely to fold and leave you hanging. Here is how the FSR scale works:

Rating Symbol Rating Variant Description
A+ A++ These companies are the most likely to meet their financial obligations.
A A- Companies with an A rating are very likely to meet their outstanding obligations.
B+ B++ Companies rated B+ or B++ are likely to meet their financial obligations.
B B- These companies have a fair chance of meeting their obligations, though they’re vulnerable to economic shifts.
C+ C++ In this category, the likelihood of meeting obligations is marginal. These companies are vulnerable to economic shifts, as well.
C C- Companies with this rating have a weak chance of continuing to meet their obligations. Very vulnerable to the economy.
D None Insurance providers who are unlikely to meet their obligations. Extremely volatile and vulnerable to the economy.

Ratings range from A+ to D, and every category except for D has a variant that defines whether the company is at the top or bottom of their respective category. For example, a company with A++ will be one of the top carriers in the A+ rating group, whereas one with a B- will be at the bottom of the B rating category.

The variants allow observers to compare companies within the same category without having to flood the table with additional ratings.

heart in hands

Reasons Why Your Health Insurance Claim May Be Denied

There is no guarantee that a health insurance claim will be honored if it has breached one of the exceptions in the agreement. There are a few cases where an insurer may deny a claim, so ensure that you don’t make a mistake that can leave you without insurance when you need it most.

Missing Information

When a claim is submitted to the insurance company, all of the info about the procedure needs to be included. It’s possible that your doctor or the hospital failed to send all of the relevant information to your insurance carrier, and they are requesting further info before they approve the claim.

For example, if your doctor included the procedure to be performed but failed to mention the reason why the procedure is necessary, your insurance company will ask for more info. This is typically only a temporary hiccup, and your claim should be covered when the info is sent.

Claims Related to Pre-existing Conditions

Filing a claim for treatment of a pre-existing condition may also result in a denial from the insurance company. Health insurance policies will rarely cover an existing condition unless it is explicitly stated in the agreement, so the money for the treatment may have to come out of your pocket.

If you have a pre-existing condition, make sure that you pay for an insurance plan that will cover it. Also, many travel health insurance plans will exclude pre-existing conditions, so if there’s a risk of a flare-up while you’re traveling, you’ll want to look for a specialized type of coverage.

The Procedure is not Medically Necessary

Another reason why insurers often refuse medical claims is when the procedure is an elective surgery. Things like cosmetic surgery will not be covered by a health insurance policy because it is considered a luxury instead of something that is needed for your quality of life.

Health insurance is meant to prevent illness and ensure that you stay healthy. However, some cosmetic surgeries may be covered by your health insurance if they can improve your quality of life. A rhinoplasty may be covered if you have breathing issues, and eyelid surgeries can be covered if your vision is naturally obstructed.

Wrong Provider

Going to the wrong healthcare provider is another reason why your insurance company may refuse you coverage, particularly if your plan doesn’t include out-of-network coverage. If you have EPO or HMO coverage, then your insurance will not apply to physicians who operate outside of your network unless it’s an emergency.

Cost Control (Step-therapy)

Insurance companies may not be willing to attempt the most effective and quick procedure immediately, as they may find it pricier than an alternative. Cost control means that an insurance company is getting you to attempt another, cheaper procedure to find out if it will resolve your issue.

If the issue is solved, then the insurance company will have saved some money. If the issue persists after the first procedure, then the insurance company will cover the next best procedure (usually the original that was denied due to the cost control measures).

doctor protecting family

Ways to Lower Health Insurance Costs

Buyers looking to save money on their health insurance have a few different options at their disposal. These include limiting doctor visits for minor ailments, finding ways to minimize your health insurance rate, and a few different choices.

Alternative Treatments for Minor Ailments

Instead of heading straight to the doctor when a light cough develops, some individuals prefer to see if they can get through their illness with bed rest. Many physicians prescribe antibiotics and other drugs for things like the common cold, but they often don’t help as much as a few nights of rest.

Paying for a visit to the doctor and then drugs every time you get a cold can get pricey, especially if you have a relatively high deductible or copay.

Quitting Smoking

As was mentioned earlier, smoking is one of the few factors under your control that can drastically alter your health insurance rates. Many insurance carriers will offer incentives for their clients to quit smoking, like a rate decrease within a year of kicking the habit.

Since smoking increases the risk of heart attacks, strokes, and several forms of cancer, a smoker is a much higher risk for insurance companies, so trying to minimize that risk will help lower premiums.

Beginning to Exercise

Another factor that you control is your fitness, and that can also make you a more attractive customer for insurance companies. Being more fit reduces the risk of several illnesses, but the most significant difference is in your cardiac health, heavily dropping the risk of heart attacks.

Insurance companies will often find ways to incentivize staying in shape for their clients. Some insurers will track your fitness progress and alter your rates depending on how much you exercise each month. Other companies will merely cover your gym bills each month.

Asking Your Doctor About Cheaper Treatment Options or Drugs

You don’t always have to accept the first treatment option that your doctor offers you, particularly if it’s one of the more expensive options. A common example is doctors offering name brand drugs instead of generics, which accomplish the same thing at a lower price.

Other than generic drugs, you can also opt for cheaper procedures that may take longer than the original option. You may wish to discuss your options with your doctor every time you are offered a treatment if you’re looking to save money on healthcare, as there are often alternatives.

Healthcare and COVID

The Novel Coronavirus epidemic has changed the way that healthcare operates across America. Some of the major shifts include COVID-19 testing outside of hospitals and the expansion of clinics to accommodate cases that require less intensive care than in hospitals.

A surprising side effect of COVID-19 is that emergency rooms are seeing a reduction of up to 50% of their capacity in some areas, as patients second-guess going to the hospital due to the risk of contracting the virus.

Of course, these events have also impacted the health insurance industry; here’s how:

How COVID Has Changed the Health Insurance Industry

One of the biggest factors that have impacted the health insurance industry since the start of COVID-19 has been the loss of work-related coverage for many Americans. As many employees are laid off or furloughed, they have also lost their benefits in a time when they are the most crucial.

Many of the unemployed workers who have lost their coverage will likely have to switch over to public insurance programs that can offer them discounted rates.

Insurers are also shouldering a larger burden by paying for COVID-19-related expenses, and that could possibly translate to elevated premiums industrywide.

Is COVID Covered by Health Insurance?

Yes, COVID-19 is covered by most general health insurance policies. The only kind of insurance that doesn’t cover COVID-19 normally is travel insurance, as it typically has exemptions for novel communicable diseases.

Urgent Care Centers

Urgent care centers are a type of clinic that is designed to take some of the burden off of emergency rooms. They provide outpatient care to people who have injuries or illnesses that require care but may not exactly necessitate a trip to the emergency room.

One of the main reasons why individuals choose to frequent urgent care centers instead of emergency rooms is because they offer much lower rates. If you have to shoulder a larger percentage of the copay for treatment, then it may be a good idea to get treatment at a cheaper urgent care center.

Private Practices

A private practice is a medical center that is owned and operated by an individual doctor instead of an organization like a hospital or even the government, though those tend to be rare in the USA.

Private practices may offer more reasonable rates than hospitals or other treatment centers, though they often have less of a presence in insurance networks. If you prefer treatment from private practices, ensure that one is a part of your insurance carrier’s provider network.

How Does Seeing a Specialist Work with Your Health Insurance?

Seeing a specialist within the same care network works differently depending on the kind of health insurance plan that you have. With an HMO or a POS plan, you will need a referral from your PCP before you can go and see a specialist for a particular issue.

Depending on your plan, you may require a written referral from your doctor. However, many carriers will also accept a simple phone call from your doctor as a referral.

Keep in mind that EPO and PPO plans don’t require a referral to see a specialist as you don’t have a PCP with those forms of health insurance.

Some newer HMO policies will allow you to see specialists within the same network without a referral, but these are still relatively rare.

medical provider in network

FAQs

How do I know which policy is better when making a comparison?

One of the first things you should look at when finding a health insurance policy is the premium. When you find two plans that have a premium within your budget, you can then start comparing them from there. Determine which of the two has a lower deductible and find out how much you’re expected to pay for coinsurance.

Two plans with identical monthly rates may end up having completely different out of pocket costs. Also, you may wish to compare the customer service ratings between the two insurance providers, as that will give you an idea of how much of a hassle they are to deal with.

How much coverage do I need?

The amount of coverage that you need is entirely dependent on your personal circumstances. A young individual in perfect health may not require anything beyond a bronze health insurance policy, as they won’t expect to go to the doctor as regularly as other policyholders.

On the other hand, someone with multiple chronic illnesses who visits the hospital once a month may require a platinum plan that will cover most out of pocket expenses. When finding out the perfect amount of coverage, you may wish to compare the potential out of pocket costs to the monthly rate to crunch the numbers and compare your potential expenditures.

Do states set limits on what health insurance companies can charge?

Yes, the vast majority of states in America will set limits on health insurance premiums, but they won’t do so directly.

Effective state review programs will have insurance carriers send the state their new rates when they are hiked, and they will be reviewed for fairness before the state approves or disapproves them.

The only states without effective rate review programs are Texas, Louisiana, Oklahoma, Missouri, and Wyoming.

Are there any states that require health insurance?

No states require you to get health insurance or face criminal punishment, but there are a few of them that have laws that will penalize you if you don’t have health insurance. These states include California, Massachusetts, New Jersey, and Vermont. Washington D.C. is not a state, but it also requires health insurance.

Health Insurance Across the 50 States

Now that this guide has covered the basics about health insurance, the focus will switch to individual states and how health insurance works in each of them.

This part of the guide will go over data from each state, including the average cost of health insurance, and the percentage of people who are insured, split up between private and public insurance. Each state will also have a short overview of their health insurance quirks and facts.

Keep in mind that the percentages for public and private health insurance are not mutually exclusive, as they count people that have been covered by both kinds of health insurance throughout the year.

Alabama

Fun fact: The state of Alabama has 133 hospitals in it.

Average annual insurance rate: $4291

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
10% 37.2% 66.6% $5,876 $16,000

Companies on the state insurance exchange: Blue Cross and Blue Shield of Alabama, Bright Health Insurance Company

Overview

Alabama has lower health insurance premiums compared to the national average. The first thing to note is that Alabama is the 46th healthiest state, as its population has a larger proportion of illnesses compared to many of its neighbors.

Diabetes is one of the main threats to your health in Alabama, as they have a much higher rate of occurrence for the disease compared to the rest of the country. Obesity also plays a role in reducing overall health in Alabama, and it contributes to a high death rate due to cardiovascular illness.

Alabama also has the ALL Kids program to provide affordable public health insurance to children under the age of 19. This program is administered through the Blue Cross Blue Shield of Alabama.

Alaska

Fun fact: Alaska is the #1 most expensive state for healthcare in America.

Average annual insurance rate: $6233

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
12.6% 34.6% 64.5% $8,058 $21,089

Companies on the state insurance exchange: Premera Blue Cross of Alaska, Moda Assurance Co.

Overview

Alaska is in a tough situation when it comes to healthcare because of its high costs, subsequently also raising insurance costs. The high cost of health insurance in the state also means that they have one of the highest uninsured rates in America, with 12.6% of the population foregoing health insurance.

Alaska’s high healthcare rates are due to their remoteness compared to the rest of America. The distance between hospitals and care facilities is another reason why healthcare costs are elevated in the state, and transportation fees make up a large part of healthcare costs, especially from remote areas.

Due to the dangerous jobs that are present in Alaska, it also has one of the highest occupational injury rates. Alaska also has one of the highest rates of physical inactivity, though that’s largely due to how challenging it is to exercise during some of the harsher months.

Arizona

Fun fact: Arizona is the 31st healthiest state in the USA.

Average annual insurance rate: $4846

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
10.6% 39.3% 62.6% $8,060 $16,999

Companies on the state insurance exchange: Blue Cross and Blue Shield of Arizona, Inc., Bright Health Company of Arizona, Cigna HealthCare of Arizona, Inc., Health Net of Arizona, Inc., Oscar Health Plan, Inc.

Overview

Arizona has comparable health insurance rates compared to the national average. Arizona uses a partial rate review system to ensure that health insurance rates aren’t increased unfairly by the carriers in the state.

Another thing to consider is that Arizona grants premium subsidies for health insurance to many of its residents. Those who had their healthcare subsidized often saw their rates drop to about $300 per month net.

Arizona has high levels of air pollution that increase the chances of respiratory illness, indirectly increasing health insurance rates. Heat exhaustion or heat stroke are both more common than in other states due to how hot it can get in Arizona, though these are usually more of a threat to very young children or the elderly.

Arkansas

Fun fact: The University of Arkansas is home to Arkansas’ only academic health system.

Average annual insurance rate: $3642

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
8.2% 44.2% 60.2% $6.742 $14,218

Companies on the state insurance exchange: Celtic Insurance Co., QCA Health Plan Inc., QualChoice Life & Health Insurance Co. Inc., USAble Mutual Insurance Co.

Overview

Arkansas has a few factors that make health insurance in the state a little more expensive, but the average rate isn’t too elevated. One of the biggest threats to the population of Arkansas’ health is obesity, with a 37% rate in adults making it the 3rd most obese state in the country.

Smoking is also relatively prevalent in the state, and they are once again 3rd in the rankings for the most smokers in America. These factors make cardiovascular illness prevalent in Arkansas, and it is the leading cause of death in the state.

One surprising thing to note about Arkansas is that there isn’t much disparity in the health status of people from different socio-economic strata. The rich in the state tend to have similar health to the poor, so treatment isn’t being administered unfairly. Unfortunately, due to Arkansas’ poor public health rankings, this means that people of all classes are equally unhealthy.

California

Fun fact: The California Health Care Foundation is a nonprofit focused on improving access to healthcare for low-income residents of the state.

Average annual insurance rate: $4173

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
7.2% 38.4% 63.7% $7,016 $18,045

Companies on the state insurance exchange: Kaiser Permanente, Blue Shield, Health Net, Molina Health Care, SHARP Health Plan, Anthem Blue Cross, Western Health Advantage, Oscar Health Plan, LA Care, Chinese Community, Valley Health

Overview

California is the 12th healthiest state in America, and it has several public programs to help make health insurance more accessible to underprivileged households. California is so healthy because of their low smoking rate and decreased premature death rate.

Because of all of this, California has relatively affordable health insurance rates when compared to the rest of the nation. People with limited income are eligible for the Medi-Cal program, which can secure them affordable health insurance with low deductibles and superior rates.

On the negative side, California has a much higher level of air pollution than many other states, increasing the risk of respiratory damage. There is also a large disparity in health between people who have and have not graduated from high school, showing that health is dependent on social class in California.

Due to all of the public health insurance subsidies available in California, it is one of the four states that penalizes uninsured residents because health insurance is required by law.

Colorado

Fun fact: Denver is the 7th healthiest city in America.

Average annual insurance rate: $4680

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
7.5% 32.7% 70.7% $7,395 $16,940

Companies on the state insurance exchange: Bright Health, Denver Medical Plan, Oscar, Friday Health Plans, Cigna, Kaiser Permanente Colorado, Anthem

Overview

Colorado is one of the healthiest states in the USA, coming in at rank 10. With health insurance rates that are just below the national average, Colorado residents can rest assured that they’re not paying an unfair rate for their coverage, and the state’s high level of fitness likely has something to do with it.

This state has some of the highest physical activity rates in the nation and conversely has lower obesity rates than many other states. All of this comes together to lower the amount of risk that an insurance company takes when they insure someone who lives in Colorado, since they’re likely to be healthier.

One of the only causes of health issues in Colorado is its high prevalence of excessive drinking, which damages the renal system and the liver. Colorado is currently planning to implement a state option for health insurance which promises to be more affordable than equivalent private coverage.

Connecticut

Fun fact: In 2009, Connecticut’s total spending on healthcare amounted to 30.4 billion dollars.

Average annual insurance rate: $4272

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
5.3% 35.8% 71.0% $7,868 $18,269

Companies on the state insurance exchange: Anthem BlueCross BlueShield, ConnectiCare

Overview

Health insurance rates in Connecticut are below the national average, and that makes sense when you consider that it is the 4th healthiest state in the country. Connecticut has high immunization rates and very low rates of disease or other health issues when compared to the surrounding states.

One of the best things about Connecticut is that it has a large number of primary care physicians, countering the understaffing that is present in nearly any other state. This results in doctors who are less stressed and overworked, indirectly reducing the possibility of mistakes and malpractice.

Despite the average good health of Connecticut residents, the state has a problem with substance abuse. Both alcohol and drug rates are higher than in many other states, and these habits can lead to health complications either immediately or later in life.

Delaware

Fun fact: Delaware has a significantly higher percentage of young smokers than its neighboring states.

Average annual insurance rate: $5152

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
5.7% 39.8% 70.6% $8,279 $18,920

Companies on the state insurance exchange: Highmark BCBSD Inc.

Overview

Delaware ranks 30th for the health of its residents, placing it around the lower middle of the list. Health insurance rates in Delaware are slightly higher than the national average, and there are a few factors that influence these elevated rates.

One of the main reasons why Delaware’s population is considered unhealthy is due to its high obesity rate. With 33.5% of adults being obese, Delaware is in the lower half of US states when ranked by the prevalence of obesity. Another issue is that the state has a relatively high rate of drug users.

Research has found that health insurance in Delaware is closely linked to the level of education of the individual. High school graduates were far more likely to be covered by health insurance when compared to dropouts.

Florida

Fun fact: In 2017, Florida saw 8.9 million visits to the ER.

Average annual insurance rate: $5398

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
13% 37.1% 62.3% $7,827 $16,009

Companies on the state insurance exchange: Blue Cross and Blue Shield of Florida, Celtic Insurance Company, Health Options, Inc., Health First Commercial Plans, Inc., Florida Health Care Plan, Inc., Oscar Insurance Company of Florida, Molina Healthcare of Florida, Inc., Bright Health Insurance Company of Florida, Cigna Health and Life Insurance Company

Overview

One of Florida’s distinguishing factors is that it has a higher rate of uninsured residents when compared to other states. This is likely linked to the elevated price of health insurance in Florida, with an average yearly rate that is about $500 higher than the national average.

A common threat to the health of Florida residents is diabetes. 12.6% of adults in the state have some form of diabetes, and this puts Florida in the top 10 states by prevalence of the disease. Mental health is also often overlooked in Florida, with a much lower rate of mental healthcare providers.

Florida’s Department of Management Services offers a few different public healthcare plans for residents that qualify. They offer both PPO and HMO options, each of which comes in a standard plan and a high deductible plan which trades a higher deductible for lower monthly rates.

Georgia

Fun fact: Georgia’s Crawford Long was one of the pioneers of using ether as an anaesthetic.

Average annual insurance rate: $5304

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
13.7% 31.2% 65.8% $7,812 $17,307

Companies on the state insurance exchange: Alliant Health Plans, Oscar Health Plan of Georgia, Kaiser Foundation Health Plan of Georgia, CareSource Georgia Co., Blue Cross Blue Shield Healthcare Plan of Georgia, Inc., Ambetter of Peach State Inc.

Overview

Georgia is another relatively pricey place for health insurance when you compare it to the national average. Once again, this results in a state with a relatively high level of uninsured residents. Surprisingly, Georgia has lower levels of public health insurance participation than states with comparable statistics.

Georgia is one of the ten worst states when ranked by public health, and the population deals with many health challenges, including diabetes, increased risk of infant mortality, and more.

Georgia’s public health insurance department is known as the Peach State Health Plan, and it encompasses the state’s Medicare, Medicaid, and PeachCare for Kids programs. It is primarily designed for disabled or low-income households that cannot afford private medical insurance.

Hawaii

Fun fact: Kuakini Medical Center in Honolulu was originally founded to offer healthcare to Japanese immigrants to Oahu.

Average annual insurance rate: $4276

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
4.1% 35.2% 76.3% $4,664 $15,959

Companies on the state insurance exchange: Hawaii Medical Service Association, Kaiser Foundation Health Plan Inc.

Overview

Hawaii is one of the healthiest states in America, coming in at #3 overall. The state has the second-lowest rate of obesity in the country, and a lower death rate from cancer than the national average. This comes together to result in surprisingly low health insurance rates and more affordable healthcare.

One of the main problems that the population of Hawaii deals with is excessive drinking, though this is offset by their exceptional health in other areas. Another condition that frequently affects the population of Hawaii is diabetes.

Hawaii is one of the few states that has adopted legislation that resembles universal healthcare. The Hawaii Prepaid Health Care Act mandates that employers must provide health insurance to any worker who works for them longer than 20 hours per week. The passage of this act gradually dropped the uninsured rate in Hawaii from over 30% to the present 4.1%.

Idaho

Fun fact: In 2018, Idaho doctors performed surgery on a rare Bengal Tiger belonging to a well-known illusionist.

Average annual insurance rate: $4125

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
11.1% 32.5% 69.7% $6,197 $16,691

Companies on the state insurance exchange: Blue Cross of Idaho, Mountain Health CO-OP, SelectHealth, PacificSource Health Plans

Overview

Idaho has a lower average health insurance rate than the rest of the country, and it’s also in the top half of the healthiest states in the country, coming in at 16th place. Some of the factors that reduce health insurance rates are the low prevalence of violent crime and pollution in the state, dropping the rate of claims.

A lower obesity rate also contributes to fewer cardiovascular diseases and deaths, and there is little disparity in health status between the upper class and the lower class. Despite this, Idaho still has a relatively large proportion of its population that remains uninsured.

Another issue in Idaho is the relative lack of primary care physicians, making waiting times longer and reducing the likelihood of timely treatment. Idaho’s Medicaid and Medicare programs are managed through the Idaho Health and Welfare department of the state government.

Illinois

Fun fact: When Chicago’s Michael Reese Hospital was founded in 1878, it was mandated that it be open to patients of all races and creeds. The hospital eventually closed in 2009.

Average annual insurance rate: $5051

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
7% 33.9% 70.2% $6,516 $17,227

Companies on the state insurance exchange: Health Alliance Medical Plans, Inc., Blue Cross Blue Shield of Illinois, Quartz Health Benefit Plans Corporation, Celtic Insurance Company, Cigna HealthCare of Illinois, Inc.

Overview

Illinois falls right in the middle of the country’s health rankings, taking the 26th place. The positive healthcare aspects of the state include a large proportion of the population that is insured and a higher number of primary care physicians than the national average, making care more accessible.

Both healthcare and health insurance in Illinois are expensive, with rates that are higher than the national average in both categories. Factors that contribute to this include the high rate of alcohol consumption as well as excessive air pollution within the state, which respectively contribute to liver and lung disease.

The Illinois Department of Healthcare and Family Services administers the state’s public health insurance programs. Compared to other states, they have a relatively modern online portal with a tool that allows individuals to select the perfect kind of insurance for their needs and economic situation.

Indiana

Fun fact: Methodist Hospital in Indianapolis has the largest neuroscience critical care department in the USA.

Average annual insurance rate: $3497

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
8.3% 33,8% 70.2% $7,462 $17,121

Companies on the state insurance exchange: CareSource Indiana Inc., Celtic Insurance Co.

Overview

Indiana’s health insurance premiums are much lower than the national average, making them one of the cheapest states for health insurance. This clashes with their average cost of medical procedures, as treatment in the state can get rather costly when compared to its neighbors.

Indiana is the 41st healthiest state in the US, and a large contributing factor is the prevalence of smokers. With the 4th-highest rate of smoking out of any state in the country, Indiana’s residents are at a much higher risk of lung cancer, heart disease, and other smoking-related illnesses.

The Healthy Indiana Plan is the state’s version of Medicaid, supporting residents who make less than $17 829 per year. This form of public health insurance may even cover trips to the optometrist or the dentist, and it is available for residents between the ages of 19 and 64.

Iowa

Fun fact: Dr. Isaac Galland was one of the first frontier doctors in Iowa to successfully treat his patients for cholera.

Average annual insurance rate: $6022

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
4.7% 35.4% 74.8% $6,446 $16,257

Companies on the state insurance exchange: Medica Insurance Company, Wellmark Health Plan of Iowa, Inc., Wellmark Value Health Plan, Inc.

Overview

Iowa’s average health insurance rates are about $1200 more expensive than the national average, making coverage in the state relatively expensive. Despite the high cost of coverage, Iowa has one of the lowest rates of uninsured residents in the country, coming in at 6th place.

Common health issues in this state include a high rate of obesity, with the state taking 7th place for the highest obesity rate in the country. Another frequent issue is excessive drinking. Even though these health problems are relatively common in Iowa, it’s still the 20th healthiest state in the US.

The Iowa Medicaid program is available to parents, disabled individuals, and the elderly, and it’s supported by the IA Health link, which allows Medicaid participants to seek care through Managed Care Organizations. The Iowa Health and Wellness Plan is designed for low-income citizens who do not fill any of the above criteria for Medicaid.

Kansas

Fun fact: The University of Kansas Health System was founded in 1906 after Dr. Simeon Bell donated his land for its use a year earlier.

Average annual insurance rate: $4585

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
8.8% 29.8% 74.3% $7,001 $16,740

Companies on the state insurance exchange: Blue Cross and Blue Shield of Kansas Inc., Cigna Health and Life Insurance Co., Medica Insurance Co., Oscar Insurance Co., Sunflower State Health Plan Inc

Overview

As the 29th healthiest state in the US, Kansas has its fair share of health issues that affect its citizens, and this is evident in the state’s high average treatment cost. Even though treatment is expensive in Kansas, its health insurance rates hover just below the national average.

Obesity is Kansas’ worst problem, with the state having the 13th-highest obesity rate in the country. This contributes to many more cases of heart disease, and Kansas has a higher death rate from cardiovascular illness compared to similar states with lower obesity rates.

With the outbreak of COVID-19, the Kansas State Employee Health Plan has been amended to offer additional services. The state will now cover medical diagnostics related to COVID-19, it will allow earlier refills of prescription drugs, and it has implemented telehealth services.

Kentucky

Fun fact: The first ovariotomy was performed by Dr. Ephraim McDowell in Green County, Kentucky.

Average annual insurance rate: $3775

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
5.6% 43.5% 64.2% $7,136 $16,622

Companies on the state insurance exchange: Anthem Healthcare Plans of KY, CareSource Kentucky Co.

Overview

Kentucky has high medical costs coupled with a relatively unhealthy population that suffers from a variety of illnesses more commonly than in other states. Kentucky has the 2nd-most smokers out of any state, meaning that its residents tend to suffer from higher rates of lung cancer and cardiovascular diseases.

Another Kentucky health issue is obesity, as the state is in 5th place nationally for the highest obesity rate. Even though the population is more prone to health problems and healthcare is relatively expensive, Kentucky surprisingly has some of the most affordable average health insurance rates in America.

Kentucky Medicaid manages access to public health insurance plans for low-income individuals who are pregnant, disabled, have children, or are over the age of 65. Due to COVID-19, they have implemented a two-month Healthcare Coverage Application that provides two-month temporary coverage for those in need.

Louisiana

Fun fact: Dr. Isaac L. Crawcour was the first doctor in Louisiana to regularly use hypodermic syringes in his treatments.

Average annual insurance rate: $5826

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
8.0% 44.4% 59.1% $7,251 $17,242

Companies on the state insurance exchange: HMO Louisiana Inc., Vantage Health Plan Inc., Louisiana Health Service & Indemnity Co., CHRISTUS Health Plan Louisiana

Overview

Louisiana’s average health insurance premiums are about $1000 per year higher than the national average. This is likely due to Louisiana’s place as the 2nd-least healthy state in the country, with one of their only positive health statistics being the relatively low rate of pollution.

Negative health factors in Louisiana include a high rate of smokers, a large number of children in poverty, a high obesity rate, a heightened prevalence of diabetes, and a high crime rate. All of this comes together to make both healthcare and health insurance more expensive in Louisiana.

Louisiana’s Department of Health manages the state’s public health insurance programs, including Medicaid and LaCHIPS (the state’s child health insurance program). With a relatively modern online portal, you are able to apply and renew your coverage online without having to leave the house.

Maine

Fun fact: Dr. Isaac M. Weber was the first board-certified surgeon in the state of Maine.

Average annual insurance rate: $5051

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
8.0% 37.3% 70.1% $6,796 $16,117

Companies on the state insurance exchange: Anthem Health Plans of ME, Harvard Pilgrim Health Care Inc., Maine Community Health Options

Overview

Maine’s annual health insurance costs are a little bit higher than the national average, but not by a significant amount. Healthcare costs in the state are also reasonably priced. A lack of air pollution or violent crime help contribute to the reasonable health insurance rates within the state.

Maine is also third in the country for prevalence of mental health providers, ensuring that the mentally ill are cared for more effectively than in the majority of the country. Smoking is one of the only negative aspects of Maine’s public health, and that also contributes to their relatively high rate of cancer deaths.

The state’s Department of Human Services administers public health insurance within its borders. MaineCare is the state’s version of Medicaid, providing affordable health insurance to underprivileged or elderly individuals who can’t afford private coverage.

Maryland

Fun fact: Johns Hopkins Hospital in Baltimore is known as one of the best hospitals in the world.

Average annual insurance rate: $3970

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
6.0% 33.3% 74.0% $7,481 $17,961

Companies on the state insurance exchange: Kaiser Permanente, CareFirst

Overview

Maryland has some relatively affordable health insurance coverage when compared to the states that are situated around it. Ranking as the 18th healthiest state in the country, Maryland is around the middle of the table, but they have a few aspects that make their public health better than average.

The most significant positive impact on Maryland’s public health comes from its small proportion of smokers, with just 12% of the population using tobacco. Maryland also has a low rate of uninsured residents, with just 6% of them foregoing health insurance.

HealthCare Access Maryland manages the state’s public health insurance programs, and you can apply in person, by phone, or online. They offer Medicaid and qualified health plans to individuals who may not have the financial means to access private health insurance.

Massachusetts

Fun fact: In the 2019-2020 rankings of US hospitals, Boston’s Mass General came in second place.

Average annual insurance rate: $5382

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
2.8% 36.6% 74.0% $6,796 $18,454

Companies on the state insurance exchange: AllWays Health Partners, Blue Cross Blue Shield, BMC HealthNet Plan, Fallon Health, Harvard Pilgrim Health Care, Health New England, Neighborhood Health Plan, Tufts Health Plan, UnitedHealthcare

Overview

Massachusetts is ranked as the 2nd healthiest state in the country, and they also have the lowest percentage of uninsured residents, with a high proportion of privately insured citizens. The state also has relatively low average healthcare costs, and very few negative public health factors.

The state has low air pollution and some of the lowest obesity rates in the country, improving public heart and lung health. The only prevalent health issues in Massachusetts are related to substance abuse, with excessive alcohol consumption and drug use being the only major public health problems.

In 2006, Massachusetts’ healthcare system was reformed, and it was mandated that employers with more than ten workers had to provide health insurance.

It also subsidized healthcare for residents of the state beneath the poverty line and helped lower the uninsured rate to its present level. The low uninsured rate is also due to the fact that health insurance is required by law in Massachusetts.

Michigan

Fun fact: Michigan’s Dr. Homer Stryker invented the Stryker Saw, a specialized cutting tool that would cut casts but not the skin beneath them.

Average annual insurance rate: $4038

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
6.5% 39.1% 71.1% $5,453 $15,628

Companies on the state insurance exchange: Blue Cross Blue Shield of Michigan Mutual Insurance Co., Priority Health, McLaren Health Plan Community, Blue Care Network of Michigan, Meridian Health Plan of Michigan Inc., Physicians Health Plan, Total Health Care USA Inc., Molina Healthcare of Michigan Inc., Oscar Insurance Co.

Overview

Aside from a low rate of uninsured residents, Michigan has a few issues with their public health. Smoking and cardiovascular deaths are two of the state’s main public health crises, with violent crime and obesity following them up.

One of the positive aspects of Michigan’s healthcare industry is that it tends to be more affordable than in other states. The average cost of individual healthcare is much lower than in other places, and the average annual insurance rate is about $800 below the national level.

The state’s public health insurance is managed by the Michigan Department of Health & Human Services, and they oversee Medicaid, the MiRx Prescription Savings Program, and more. Additionally, the Healthy Michigan Plan is a state program that exists to make healthcare easier to access for many inhabitants.

Minnesota

Fun fact: The Mayo Clinic in Rochester, Minnesota has consistently ranked as the best hospital in the United States.

Average annual insurance rate: $4221

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
4.4% 33.2% 76.1% $7,463 $16,925

Companies on the state insurance exchange: HMO of Minnesota, Medica Insurance Company, Group Health Plan Inc., UCare Minnesota

Overview

Minnesota takes its healthcare seriously, and it comes in at #7 on the list of the healthiest states in America. While the average healthcare cost is relatively close to the national level, insurance is more affordable, and that is evidenced by the low rate of uninsured individuals in Minnesota.

Low air pollution and relatively few cardiovascular deaths are some of the most notable positive factors in the state’s public health. Out of the few negative factors, the only significant ones are a high rate of excessive drinking and a low prevalence of immunizations in children.

There are two public health programs in Minnesota, and both of them are managed by the state’s Department of Health. The first of them is Medical Assistance, which covers medical care for low-income individuals. On the other hand, MinnesotaCare provides coverage for uninsured Minnesotans who are working.

Mississippi

Fun fact: Many Mississippi physicians were involved in the Civil Rights Movement, including T.R.M. Howard, Aaron Shirley, and Gilbert R. Mason.

Average annual insurance rate: $4821

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
12.1% 38.9% 60.5% $7,327 $16,081

Companies on the state insurance exchange: Molina Healthcare of Mississippi, Ambetter of Magnolia

Overview

Mississippi has been ranked as the unhealthiest state in the USA, and there are many ailments that plague the state’s population relatively commonly. In spite of this, Mississippi features relatively affordable annual healthcare costs and health insurance rates that are in line with the national average.

Getting the positive aspects out of the way first, Mississippi has relatively low rates of substance abuse, taking 3rd place for the lowest rate of excessive drinking. However, this is offset by skyrocketing obesity rates, large numbers of smokers, high rates of cardiovascular and cancer deaths, as well as many uninsured residents.

The Mississippi Department of Health is responsible for administering the State Health Plan, which provides coverage for the disabled, pregnant mothers, and other uninsured individuals.

Missouri

Fun fact: Dr. John Sappington developed a quinine pill to counteract the transmission of malaria through the Missouri Valley in the 19th century.

Average annual insurance rate: $5772

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
9.4% 32.7% 70.3% $7,127 $16,849

Companies on the state insurance exchange: Healthy Alliance Life Co (Anthem BCBS), Celtic Insurance Company, Cox Health Systems Insurance Company, Cigna Health and Life Insurance Company, Medica Insurance Company, Oscar Insurance Company, SSM Health Insurance Company

Overview

Missouri is the 39th healthiest state in America, a number which is mostly influenced by the large number of smokers that inhabit it. With 19.4% of the adult population identifying as smokers, Missouri is the state with the 10th highest percentage of them.

Another negative part of Missouri’s public health is the large number of obese individuals, making the state the 9th most obese. The most positive aspect that influences public health in this state is the relative lack of air pollution, though the benefits to lung health are diminished by the large number of smokers.

Missouri’s public health insurance programs provide coverage to citizens over the age of 65 and people earning less than 85% of the federal poverty level. Missouri HealthNet coverage also applies to all disabled residents and blind people who earn less than 100% of the federal poverty level.

Montana

Fun fact: Billings’ Saint-Vincent Healthcare is known for their expertise in knee replacement surgeries.

Average annual insurance rate: $4553

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
8.2% 40.2% 66.6% $7,005 $17,317

Companies on the state insurance exchange: Montana Health Cooperative, PacificSource Health Plans, Blue Cross and Blue Shield of Montana

Overview

Montana’s public health rankings are dead average, with the state coming in 24th place. Low rankings in air pollution and obesity help improve the overall health of the state’s population and ensure that cardiovascular deaths are below the national average.

These positive public health aspects are countered by the large number of smokers in Montana: 18% of the adults in the state. Montana also suffers from a lack of primary care physicians, making treatment harder to come by and lengthening the waits for patients who need care.

Oversight for public health insurance in Montana falls under the DPHHS, and they offer both Medicaid and HELP plans (also known as Medicaid Expansion policies). Medicaid is the older version of the system and is typically used for grandfathered residents, while new applicants almost exclusively use HELP.

Nebraska

Fun fact: The University of Nebraska Medical Center’s first medical teacher was Dr. A.S. von Mansfelde.

Average annual insurance rate: $6129

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
8.3% 28.8% 75.1% $7,639 $16,201

Companies on the state insurance exchange: Medica Insurance Company, Bright Health Insurance Company

Overview

Nebraska is a relatively healthy state that is held back by its higher rates of excessive drinking and obesity, both of which can adversely affect your overall health. Even though these issues are relatively prevalent in the state, they are still the 17th healthiest in America.

Things that have a positive impact on statewide health include the high number of immunizations for children, the low rate of air pollution, and a relative lack of violent crime and drug deaths. Even though the state is relatively healthy, insurance costs are more than $1200 per year higher than the national average.

Nebraska’s public health insurance is known as the Nebraska Medical Assistance Program, and it exists to ensure that low-income families, seniors, and disabled individuals have access to medical insurance.

Nevada

Fun fact: The dean of the School of Medicine at the University of Nevada, Thomas L. Schwenk, focuses much of his research on depression and burnout in medical students.

Average annual insurance rate: $5163

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
11.2% 34.9% 64.9% $7,116 $17,434

Companies on the state insurance exchange: Health Plan of Nevada Inc., SilverSummit Healthplan Inc., Anthem Inc.

Overview

Nevada has higher average health insurance premiums than the average rate across the USA, though they only amount to about $300 per year more. When it comes to public health, Nevada ranks 35th due to a few different factors.

The most significant negative influence on Nevada’s rating is the rate of violent crime, amounting to over 500 offenses per 100 000 inhabitants. There is also a severe shortage of primary care physicians in the state, and much of the population is uninsured.

Positive factors include a low number of preventable hospitalizations, a low rate of obesity, and a lower rate of smoking and excessive drinking. Public health insurance and subsidies are managed by the Nevada Department of Health and Human Services as well as Nevada HealthLink.

New Hampshire

Fun fact: The Southern New Hampshire Health System was initially founded in 1893 as Nashua Memorial Hospital.

Average annual insurance rate: $4541

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
5.7% 32.3% 75.8% $8,289 $19,208

Companies on the state insurance exchange: Celtic Insurance Company, Harvard Pilgrim Health Care of NE, Matthew Thornton Health Plan

Overview

New Hampshire has below-average health insurance rates by about $300 when compared to the national average, though the average cost of healthcare is among the highest in the country. Despite (or perhaps because of) these high medical costs, New Hampshire is the 6th healthiest state in the country.

The only serious negative influence on the state’s health is drug use, with 35 drug-related deaths per 100 000 people. On the positive side of things, New Hampshire has low pollution, less violent crime, reduced infant mortality, and a high rate of childhood immunization.

Public health insurance is managed under the NH Medicaid system, and the program is open to low-income families, pregnant women, the elderly, and the disabled. NH Medicaid has also implemented new measures to combat COVID-19, including an optional eligibility group for COVID-19 testing coverage.

New Jersey

Fun fact: Dr. Ebenezer Elmer of Bridgeton served as a soldier in the Continental Army, practiced medicine in his hometown after being discharged, and eventually became a member of the New Jersey General Assembly.

Average annual insurance rate: $4865

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
7.4% 31.2% 72.8% $7,002 $18,280

Companies on the state insurance exchange: AmeriHealth HMO, AmeriHealth Insurance Company, Horizon Healthcare Services, Oscar Insurance

Overview

New Jersey is one of the healthiest states in the country, taking 8th place on the list. Coupled with the healthy population, New Jersey has average medicare costs for individuals and health insurance costs that are nearly equivalent to the national average.

Drug deaths and physical inactivity make up the only major negative factors that influence public health in the state, with most other fields being above average. For example, New Jersey has a much lower obesity rate than the rest of the country and fewer smokers than average.

The Department of Human Services of the state administers public health insurance programs, and Get Covered New Jersey manages the insurance marketplace. Keep in mind that New Jersey is one of the few states with mandatory health insurance, and going without it may leave you vulnerable to a penalty.

New Mexico

Fun fact: New Mexico has a shortage of doctors, resulting in higher average salaries but also elevated workloads.

Average annual insurance rate: $3868

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
9.5% 49.4% 54.3% $6,652 $17,349

Companies on the state insurance exchange: Blue Cross Blue Shield of New Mexico, Molina Healthcare of New Mexico, Inc., New Mexico Health Connections, True Health New Mexico, Inc.

Overview

The first thing to note about New Mexico is that it has lower health insurance rates than the majority of the country, though a large proportion of the population is still uninsured. As was just mentioned, one of the most notable things about New Mexico is that it’s suffering one of the nation’s worst doctor shortages.

New Mexico ranks 37th in the country for public health, and this is influenced by things like the high violent crime rate in the state, with 857 offenses per 100 000 people. Along with that, there is a high prevalence of low birthweight, as well as a population that is commonly physically and psychologically distressed.

A low rate of pollution and widespread access to mental healthcare providers helps balance out the numbers, bumping New Mexico’s rank up slightly. Medicaid in the state is managed by beWellnm, and they benefit from more funding than comparable agencies in other states.

New York

Fun fact: NewYork-Presbyterian Hospital is associated with the medical departments of both Columbia and Cornell.

Average annual insurance rate: $7954

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
5.4% 39.9% 67.2% $7,393 $19,630

Companies on the state insurance exchange: CDPHP, Health First, Oscar, EmblemHealth, UnitedHealthCare, Fidelis Care, MetroPlus Health Plan, MVP Health Care, Univera HealthCare, BlueShield of Northeastern New York, Excellus, Blue Cross Blue Shield of Western New York, Empire Blue Cross, Empire Blue Cross Blue Shield, Independent Health, Solstice Health Insurance Company, Healthplex Insurance Company

Overview

New York places 11th in the list of the healthiest states in America, and they have very few negative factors that are beneath the national average. Some of the factors that make new york so healthy include a low smoking rate, surprisingly little air pollution, and a low rate of obesity.

While healthcare in New York isn’t that far off from the national average, the cost of health insurance is among the highest in the country. New Yorkers find themselves paying nearly double the national average for health insurance.

GetCoveredNYC helps low-income or disabled residents find affordable healthcare plans if they are not able to get private coverage. You can either apply through their online portal or call the public help hotline to get into contact with a representative that will guide you through picking a plan.

North Carolina

Fun fact: The first meeting of the North Carolina Medical Society took place in 1799.

Average annual insurance rate: $5398

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
10.7% 34.7% 67.3% $8,015 $17,141

Companies on the state insurance exchange: Blue Cross and Blue Shield of NC, Ambetter of North Carolina Inc., Bright Health Company of North Carolina, Cigna HealthCare of North Carolina Inc.

Overview

North Carolina is considered the 36th healthiest state in America, and it has many metrics that are below the national average for public health. With about 7 deaths per 1000 live births, North Carolina has one of the highest relative rates of infant mortality in the country.

There is also a large proportion of the population that is obese, and smoking is relatively common in the state. These negative factors are offset by a low level of air pollution and the lack of a predilection for excessive drinking.

Medicaid in the state is administered by the NC Medicaid Division of Health Benefits, leaving them responsible for examining applications and helping residents get coverage. Most doctor services are covered under NC Medicaid, including visits to the eye doctor or the dentist.

North Dakota

Fun fact: Sanford Medical Center Bismarck is considered one of the top hospitals in the state.

Average annual insurance rate: $3497

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
7.3% 26.5% 79.7% $6,511 $16,020

Companies on the state insurance exchange: Blue Cross Blue Shield of North Dakota, Medica Health Plans, Sanford Health Plan

Overview

North Dakota is one of the USA’s healthier states, taking the 14th place in the list. They also have a relatively low average cost of healthcare for individuals and families. This is coupled with affordable health insurance rates that make it easier to access healthcare in the state when necessary.

A relatively large proportion of North Dakota’s population smokes, and obesity rates are relatively high, but most other negative factors are relatively tame. A high rate of childhood immunization and low levels of air pollution help contribute towards a healthy populace.

Unfortunately, North Dakota’s public health insurance sectors are relatively underfunded, with an archaic Medicaid website that makes it difficult to determine whether or not you’re eligible. The recent North Dakota Medicaid expansion has also widened access to the program.

Ohio

Fun fact: Ohio’s first governor, Edward Tiffin, was also Chillicothe’s first physician in the preceding years.

Average annual insurance rate: $3861

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
6.5% 37.5% 67.6% $6,563 $16,900

Companies on the state insurance exchange: Community Insurance Company, CareSource, Ambetter Buckeye Community Health Plan, Medical Health Insuring Corp. of Ohio, Oscar Insurance Corporation of Ohio, Molina Healthcare of Ohio, Inc., AultCare Insurance Company, Paramount Insurance Company, Oscar Buckeye State Insurance Corp., Summa Insurance Company, Inc.

Overview

Along with affordable healthcare, Ohio also has relatively cheap health insurance, at about $1000 below the national annual average. Even though healthcare is relatively accessible in the state, Ohio places 38th in the list of the healthiest states in America.

Proportionally, Ohio has some of the most smokers in America, at about 20% of the population. Drug deaths are another significant factor that affects the public health of Ohio residents. Finally, about 34% of adults in the state are obese, furthering the rate of cardiovascular disease.

It isn’t all bad, though, as Ohio has a relatively low rate of violent crime. Public health insurance is managed by the Ohio Department of Medicaid and Ohio Benefits, depending on the kind of coverage required and the circumstances of the applicant.

Oklahoma

Fun fact: Dr. Fred S. Clinton was instrumental in building the first hospital in Tulsa.

Average annual insurance rate: $4797

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
14.2% 34.6% 64.1% $7,826 $16,811

Companies on the state insurance exchange: Blue Cross Blue Shield of Oklahoma, Bright Health Insurance Company, Medica Insurance Company

Overview

Oklahoma is the 46th healthiest state in America, and it has rather pricey individual healthcare, making it hard for uninsured individuals to seek treatment. The state has the 2nd most uninsured inhabitants in the country.

Other factors that contribute to Oklahoma’s low public health ranking include a large number of smokers and a high rate of cardiovascular deaths. These heart diseases are likely related to the state’s large obese population, with a rate of just under 35%.

The state government’s online presence is also lacking, with an online portal that is difficult to navigate due to its poor layout. It is likely easier to apply through the Oklahoma Department of Human Services website or to do so through the phone.

Oregon

Fun fact: Robert Newell started off as a frontier doctor and a fur trapper in the 19th century and eventually worked his way up to the Oregon State Legislature.

Average annual insurance rate: $3945

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
7.1% 39.2% 67.7% $6,769 $17,141

Companies on the state insurance exchange: BridgeSpan Health Company, Kaiser Foundation Healthplan of the NW, Moda Health Plan, Inc., PacificSource Health Plans, Providence Health Plan

Overview

Oregon has premiums that are lower than the national average by about $900, making private health insurance a little more affordable. Along with this, average healthcare costs aren’t quite as high as in some of the other states on the West Coast.

This state ranks 22nd in national health, though many of the negative factors don’t directly impact health. For example, Oregon has a high rate of high school dropouts, but this only indirectly affects public health. The only major negative factor is that Oregon residents are under physical distress relatively frequently.

Positive factors include a low rate of preventable hospitalizations and a large number of mental healthcare providers. The Oregon Health Plan is tasked with providing low-income and disabled or elderly Oregonians with affordable health insurance, and they may be contacted online or through the phone.

Pennsylvania

Fun fact: Benjamin Rush, a physician and one of the signers of the Declaration of Independence, hailed from Byberry, Pennsylvania.

Average annual insurance rate: $4443

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
5.5% 37.4% 72.4% $7,134 $17,344

Companies on the state insurance exchange: UPMC Health Options, Inc., Geisinger Health Plan, Highmark Inc., Capital Advantage Assurance Company, Geisinger Quality Options, Highmark Choice Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., Independence Blue Cross, Keystone Health Plan East, Inc., Pennsylvania Health & Wellness, Inc., Oscar Health Plan of Pennsylvania, Inc.

Overview

Health insurance premiums in Pennsylvania are relatively affordable, with the average cost being about $400 per year lower than it is nationwide. Pennsylvania also has one of the lowest rates of uninsured inhabitants in the country, at 5.5%, improving its public health ranking.

Despite the prevalence of health insurance, Pennsylvania is still only the 28th healthiest state in America. The numbers are heavily skewed by the large proportion of drug deaths coupled with many inhabitants being under frequent distress mentally.

Pennsylvania’s Department of Human Services administers their public health insurance programs, and it includes the CHIP (Children’s Health Insurance Program) and Medicaid. In Pennsylvania, Medicaid is referred to as the Medical Assistance Program.

Rhode Island

Fun fact: Providence’s Dr. Solomon Drowne was nearly captured in New York by British forces when he was collecting medical supplies for the Continental Army.

Average annual insurance rate: $3426

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
4.1% 38.7% 70.0% $7,486 $17,590

Companies on the state insurance exchange: Blue Cross & Blue Shield of Rhode Island, Neighborhood Health Plan of Rhode Island

Overview

Rhode Island is ranked as the 13th best state by the metric of public health, and most of its inhabitants have some form of health insurance, giving them one of the lowest uninsured rates in the country. Unfortunately, there are a few public health issues that hold Rhode Island back.

One of the most common factors that contribute to negative public health is the high proportion of drug deaths in Rhode Island. Other than this, most negative influences aren’t too far off from the national average, explaining how the state ranks so highly in the public health domain.

There are two major public health insurance programs in Rhode Island, and they are managed by the Executive Office of Health & Human Services. Medicaid in the state is known as Rite Care, and Rite Share is a program that provides subsidies to employers for their employee health insurance policies.

South Carolina

Fun fact: Alonzo Clifton McLennan of Columbia helped pave the way for African American doctors and nurses in his state.

Average annual insurance rate: $4600

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
10.5% 37.8% 65.9% $7,137 $16,764

Companies on the state insurance exchange: Absolute Total Care Inc., BlueCross BlueShield of South Carolina, Bright Health Company of South Carolina, Molina Healthcare of South Carolina Inc.

Overview

South Carolina is 42nd in the US when ranked according to their public health. Some of the reasons why this state is ranked so low include a high rate of obesity and diabetes. The state is also home to a large number of smokers and its premature death rate is elevated.

Positive public health influences in South Carolina include a low rate of excessive drinking and air that isn’t polluted. Even though South Carolina isn’t as healthy as the average US state, the cost of healthcare and health insurance both hover around their respective national averages.

The South Carolina DHHS is responsible for administering public health insurance plans, including Medicaid and Medicare. Both of these programs are designed to insure people who can’t afford private insurance, though the latter is meant for seniors.

South Dakota

Fun fact: The top-ranked hospital in South Dakota is the Sanford USD Medical Center.

Average annual insurance rate: $4885

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
9.8% 30.4% 72.0% $8,286 $16,194

Companies on the state insurance exchange: Avera Health Plans Inc., Sanford Health Plan

Overview

South Dakota is the 25th healthiest state in America, putting it right in the middle of the pack. The state features health insurance premiums that match the national average, though the typical cost of healthcare within the state is much higher than it is nationwide.

The two main factors that reduce the public health ranking of this state include smoking and excessive drinking. Another issue in South Dakota is the lack of primary care providers, meaning that patients will have to wait a longer time before they can receive treatment from a physician.

The South Dakota Department of Health manages all public health insurance policies through Medicare or Medicaid. There is also the South Dakota Medical Assistance for Low Income Families program, also known as the LIF.

Tennessee

Fun fact: Bill Frist, a two-term Republican senator from Tennessee, began his career as a lung and heart transplant surgeon.

Average annual insurance rate: $6218

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
10.1% 37.1% 65.8% $7,900 $15,635

Companies on the state insurance exchange: BlueCross BlueShield of Tennessee, Bright Health Insurance Company of Tennessee, Celtic Insurance Company, Cigna Health and Life Insurance Company, Oscar Insurance Company

Overview

Tennessee takes 44th place in the list of the healthiest states due to a variety of factors that plague its population. It also has some of the most expensive healthcare costs for individuals, nearly reaching the $8000 per year mark.

The main cause of the state’s low health ranking is the prevalence of cigarette smokers, at 20% of the adult population. Another common issue in the state is the rate of violent crime, with about 624 offenses per 100 000 people. Premature deaths are also more frequent than the national average, as are cancer deaths.

In Tennessee, Medicaid is known as Tenncare, and it is provided to low-income residents in partnership with community clinics. All information is available through the website of the Tennessee state government, which is logically laid out and seems to be well-funded.

Texas

Fun fact: In the 1850s, Dr. Ferdinand Ludwig Herff pioneered the use of chloroform in San Antonio.

Average annual insurance rate: $4493

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
17.7% 29.0% 61.8% $8,239 $17,216

Companies on the state insurance exchange: Blue Cross Blue Shield of Texas, FirstCare Health Plans, CHRISTUS Health Plan, Community Health Choice, Inc., Celtic Insurance Company, Sendero Health Plans, Inc., Oscar Insurance Company, Molina Healthcare of Texas, Inc.

Overview

With insurance rates below the national average, it’s surprising that healthcare costs in Texas are among the highest in the country for both individuals and families. Texas also has one of the highest proportions of underinsured inhabitants, at a whopping 17.7%.

The most significant factor that contributes to the low health ranking of the state aside from the uninsured populace is the prevalence of obesity. Diabetes is yet another common illness in the state, and Texas also lags behind on child immunizations. Positive factors include a low smoking rate and a low death rate from cancer and drugs.

The THMP manages Texas’ public healthcare programs, including the Medicaid and Texas Health Steps programs, designed to provide coverage for low-income individuals and others who qualify. There is also a program for children with special needs, one for women’s health and family-planning, as well as long-term care.

Utah

Fun fact: The University of Utah Hospital is the best in the state, offering airlift services and holding a speciality in orthopedics.

Average annual insurance rate: $4197

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
9.4% 21.3% 78.5% $7,320 $15,998

Companies on the state insurance exchange: BridgeSpan Health Co., Cigna Health and Life Insurance Co., Molina Healthcare of Utah, SelectHealth, University of Utah Health Insurance Plans

Overview

Utah is one of the healthiest states in the country, taking 5th place on this list of the top states by public health. The state also features reasonable annual health insurance rates that are around $700 lower than the national average, though the cost of individual healthcare is a little high.

Utah’s population is extremely healthy, with the lowest smoking and drinking rates in the country, as well as the fewest cancer deaths out of any state. In fact, the main aspect that drops Utah’s health rating is a relative lack of physicians, stretching out wait times and making it harder to seek out treatment.

The state has several public health insurance programs, including Medicaid, Medicare, CHIP, and a few others that are unique to the state. These unique programs include Baby Your Baby, Utah’s Premium Partnership for Health Insurance, and the Primary Care Network (PCN).

Vermont

Fun fact: Dr. Frederick Aubrey of Bradford helped treat General Wolfe’s mortal wounds after the English victory in the Battle of the Plains of Abraham.

Average annual insurance rate: $6356

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
4.0% 40.6% 69.9% $7,264 $17,835

Companies on the state insurance exchange: Blue Cross Blue Shield of Vermont, MVP Health Plan

Overview

The first thing to note about Vermont is that it is one of four states that legally mandates health insurance for its inhabitants. This contributes to the state’s extremely low number of uninsured residents, but a downside is that Vermont has extremely high average annual rates.

Despite the high insurance rates, the cost of healthcare isn’t that much higher than in other states, so some residents may struggle to pay their insurance premium. This is where Vermont’s public health insurance programs come into play.

In 2011, Vermont attempted to create the first successful single-payer universal healthcare system in the United States. This system was known as Green Mountain Care, and it was in place for three years, until it was abandoned at the end of 2014.

Virginia

Fun fact: Thomas Walker, a physician from Walkerton, was instrumental in exploring much of his home state.

Average annual insurance rate: $4988

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
8.8% 28.6% 75.4% $8,104 $17,566

Companies on the state insurance exchange: CareFirst BlueChoice Inc., Cigna Health and Life Insurance Co., Group Hospitalization and Medical Services Inc., HealthKeepers Inc., Kaiser Foundation Health Plan of the Mid-Atlantic States Inc., Optima Health Plan, Oscar Insurance Co., Piedmont Community HealthCare HMO Inc., Virginia Premier Health Plan Inc.

Overview

While Virginia’s health insurance costs are below the national average, the cost of healthcare in the state is far higher than most other places in the country. This can result in much higher coinsurance that needs to be paid by the policyholder before their carrier will pay out.

The only public health issues in Virginia that are worse than the national average include access to mental healthcare providers as well as primary care providers. It is evident that the state is suffering from a shortage of doctors, and this can make treatment harder for everyone to access.

Virginia public health insurance programs include Medicaid for residents who earn less than $17 237 and the FAMIS program for children in underprivileged households. Pregnant women in Virginia must apply for their benefits separately, and they will last through the pregnancy until 60 days after birth.

Washington

Fun fact: The University of Washington Medical Center is the best hospital in the state, and it’s nationally ranked in the top 50 across six different specialties.

Average annual insurance rate: $4080

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
6.4% 35.9% 70.6% $6,258 $16,627

Companies on the state insurance exchange: Kaiser Permanente, LifeWise, Molina Healthcare, Premera Blue Cross, Coordinated Care

Overview

Washington is the 9th healthiest state in the Union, and its negative factors don’t even directly impact the health of its population, but rather do so indirectly. A high rate of high school dropouts is the main factor that affects the state’s health rating negatively.

As for positive factors, Washington state has the third lowest smoking rate in the nation with only 12% of adults using cigarettes or other tobacco products. Infant mortality and preventable hospitalizations in Washington are also much lower than in other states.

Washington’s recent Cascade Care initiative seeks to provide a public health insurance option at more affordable rates to the state’s population. This is accomplished through partnering with private health insurance firms with the state government stringently overseeing rates.

West Virginia

Fun fact: West Virginia University first set up its medical department in 1960. In 1984, the hospital became its own separate entity.

Average annual insurance rate: $5316

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
6.4% 47.1% 62.8% $6,053 $18,322

Companies on the state insurance exchange: CareSource West Virginia Co., Highmark Blue Cross Blue Shield West Virginia

Overview

Coming in at 45th on the list of public health rankings by state, West Virginia’s public suffers from a few ailments at a higher rate than the national average. The state has the most smokers, the highest rate of drug deaths, and the second-highest obesity rate in the country.

These are offset by the second-lowest rate of excessive drinking in the country, somewhat balancing out the negative effects of the other factors on public health. Another positive is that West Virginia puts more money than average into their public health funding.

Public health insurance in West Virginia is managed by the state’s Department of Health & Human Resources. They manage the state’s Medicare and Medicaid programs, and they have recently started offering COVID-19 testing coverage.

Wisconsin

Fun fact: The first female physician in Wisconsin was Dr. Laura Ross Wolcott.

Average annual insurance rate: $4936

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
5.5% 33.0% 74.8% $7,379 $17,662

Companies on the state insurance exchange: Aspirus Arise Health Plan of Wisconsin, Inc., Children’s Community Health Plan, Common Ground Healthcare Cooperative, Dean Health Plan, Group Health Cooperative of South Central Wisconsin, HealthPartners Insurance Company, Medica Community Health Plan, MercyCare HMO, Inc., Molina Healthcare of Wisconsin, Inc., Network Health Plan, Quartz Health Benefit Plans Corporation, Security Health Plan of Wisconsin, Inc., WPS Health Plan, Inc.

Overview

Wisconsin’s public health rankings are relatively average, with the state placing 23rd. Even though its ranking is average, the state doesn’t have many negative factors that highly exceed the national average, with the only widespread problem being excessive alcohol consumption.

On the other hand, Wisconsin has a low rate of air pollution, a large number of insured residents, low diabetes and violent crime rates, as well as little disparity in health status between classes. While healthcare costs are a little higher than average, the annual insurance rate is very close to the national average.

People in Wisconsin who cannot access private health insurance have access to a few programs including BadgerCare Plus (the state’s public healthcare program). There is also Wisconsin Medicaid for seniors, disabled individuals, and the blind. The online ACCESS tool makes it easy for residents to determine which program they are eligible for.

Wyoming

Fun fact: The Wyoming State Hospital was originally founded in 1887 as a mental institution.

Average annual insurance rate: $7081

% Uninsured % Public Health Insurance % Private Health Insurance Average Annual Cost of Healthcare (Individual) Average Annual Cost of Healthcare (Family)
10.5% 27.3% 74.9% $6,804 $17,015

Companies on the state insurance exchange: Blue Cross Blue Shield of Wyoming

Overview

Ranked 19th for public health in the USA, the population of Wyoming deals with only a few medical issues at a higher rate than the rest of America. One of the most common negative effects on public health is smoking, with 18.8% of the state’s adult population using tobacco.

Wyoming also has the highest rate of workplace fatalities in the USA due to its relatively small working population and the widespread presence of heavy industries. Positive aspects of the state’s public health include low rates of air pollution, violent crime, and diabetes.

Medicaid and CHIP programs in the state are administered by the Wyoming Department of Health. There are also other programs designed for pregnant women, the elderly, disable workers, individuals who have suffered brain injuries, and more.

Conclusion

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Staying in good health is one of the most important things that any person can do, as it will drastically improve your chances of living a long and fulfilling life. Health insurance can help prevent the financial burdens that are frequently associated with healthcare, but not knowing how to find the right policy can create some money issues of its own.

Ideally, this guide has been able to provide you with all the relevant information about health insurance, including how to lower your rates and any health insurance quirks about your state. Keep in mind that finding the ideal health insurance plan is dependent on you and your needs, as there is no such thing as a one-size-fits-all policy.

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