Health Insurance Pricing Information

Paying for medical treatment out-of-pocket is outside the realm of affordability for many families and individuals. Health insurance offers an option for receiving medical treatment at a reduced cost, but requires a monthly premium payment. Health insurance pricing methods make it difficult to know if you're getting the best deal possible, but there are several factors that will impact what you pay regardless of what insurance you have.

Options

• Health insurance providers offer different pricing options for different types of insurance. Group insurance, which is available to employers for offering employee benefits and to members of certain social organizations, distributes health risks over a large group of people, bringing its cost down. Government programs such as Medicare and Medicaid base costs on your income or what level of subsidized insurance you choose to purchase. Individual health insurance, which you can buy directly from an insurance company, features pricing based on your own health factors.

Factors

• If you opt for an individual health insurance plan, the insurance company will determine the cost to you by using several factors. Items such as age, gender and medical history all play a large part in insurance pricing. This also means that if you have preexisting medical conditions, you may find individual health insurance to be prohibitively expensive.

  Medicaid is a government program for low-income families. It doesn't feature a monthly premium but instead bases its costs to patients on their income, with some receiving care for free. Medicare is a government program for the elderly. It allows eligible individuals to purchase different levels of low-cost coverage. More comprehensive coverage carries a higher price tag than minimal coverage but still costs less than comparable coverage through a private insurer.

Complications

• Health care pricing is a complicated issue that leaves many customers unable to determine the relationship between what they pay for insurance and what the care they receive actually costs. According to Forbes, health insurance providers often withhold pricing information in order to facilitate profitable deals with health care providers. In addition, doctors and other practitioners may not make patients aware of what the care they provide costs so that they can control what they charge for various services and procedures.

Changes

• Some health insurance providers display their pricing policies to customers. However, this information isn't available in all markets. Some insurers that do list their prices only offer general figures instead of doctor-specific prices, making it difficult for patients to perform fair comparisons.

  Federal legislation also plays a role in health insurance pricing transparency. The Patient Protection and Affordable Care Act, which Congress passed in March 2010, contains new regulations for the health care industry in an effort to make more information, including pricing information, readily available to those who have health insurance or are in the process of shopping for it.