Cheapest Affordable Care Act Plan Depends on Your Age & Medical Use

Dec 19, 2013, 10:44 ET from HealthPocket

Top-Tier plans not necessarily the most expensive

SUNNYVALE, Calif., Dec. 19, 2013 /PRNewswire-USNewswire/ -- Using the average premiums for the four main categories of Affordable Care Act health plans, HealthPocket analyzed how healthcare use and enrollee age affected which health plan had the lowest annual combination of premiums and out-of-pocket costs.

While Bronze health plans were the least expensive plan with respect to average premium, other plans were less expensive depending on the medical usage scenario. For example, even though they have the highest premiums, the top-tier Platinum Plans averaged lower total annual costs than a Bronze Plan when a 30-year-old visited a primary care doctor 4 times a year and a specialist four times a year. If a 30-year-old had no specialist visits but visited a primary care doctor 8 times a year then the Silver Plan had the lowest combination of premiums and out-of-pocket costs annually.  

For 60-year-olds, Bronze Plans were the least expensive choice for up to 12 primary care visits per year. However if a 60-year-old visited a specialist between nine and twelve times and their primary care physician four times, then the total annual costs would be lowest for Platinum Plans.

Average monthly premiums increased when moving from lower-tier metal plans that covered less medical expense to higher-tier plans that covered more but they did not rise proportionately to the increase in medical expenses covered. Although each step up in metal tier (Bronze, Silver, Gold, Platinum) covers 10% more medical costs for an enrollee group than the previous metal tier, the average Silver Plan premium was 8% higher than the Bronze Plan average, the Gold Plan 18% higher than the Silver Plan, and the average Platinum Plan premium was 3% higher than the Gold Plan.

"Our research demonstrates the importance of considering anticipated out-of-pocket costs as well as premiums when choosing a health plan," said Kev Coleman, Head of Research & Data of HealthPocket. "The scenarios in this report provide directional guidance on health plan selection but consumers must still investigate the actual premiums and cost-sharing for their local health insurance plans in order to make a financially wise choice."

The full study, "Healthcare Usage & Choosing the Least Expensive Affordable Care Act Plan," can be found at is a free website that compares and ranks all health insurance plans available to an individual, family, or small business so consumers can make their best health plan decision and reduce out of pocket costs. HealthPocket uses only objective data from government, non-profit, and private sources that carry no conditions that might restrict the site from serving as an unbiased resource. Learn more at

For more information please contact Emily Cashel with Shirley & Banister Public Affairs at or (703) 739-5920 or (800) 536-5920.

SOURCE HealthPocket