Breaking Down Insurance Premium Costs

• Make health insurance more affordable for more of us.
• Expand Medicaid, jointly-funded federal-state health insurance for low-income people.
• Encourage new methods of care delivery that lowers costs.

Here’s How Healthcare.Gov Breaks down That 80%: 

• 2.1 cents for prescription drugs, which include outpatient, physician- and self-administered medications. This doesn't include those given in in-patient settings.  
• 22 cents for doctor services.
• 19.8 cents for outpatient services, like ER care, labs, imaging clinics, physical therapy, urgent care, etc.
• 15.8 cents for inpatient services, typically hospital care.

How is the Remaining 20% Broken Down?

• 18% or 17.8 cents for operating costs, including communicating with plan members, running customer service operations, quality reviews, data analysis and other activities.
• 3%* of every dollar is the profit for the health plan. 

How to Reduce Insurance Premium Costs

• Ask for help from your human resources department or your insurance broker to learn about and choose your most affordable health plan.
• Remember that using doctors in your plan costs less than going “out-of-network.”
• See if a consumer-driven health plan (CDHP) such as a high-deductible plan with lower premiums might be right for you.
• Consider starting an HSA, flexible spending arrangement (FSA), or health reimbursement arrangement (HRA). These plans have tax advantages.
• Use prevention and wellness services, especially if you've been advised by your doctor to make lifestyle changes to improve your health.
• Use urgent care instead of the emergency department for non-emergency care.

*AHIP: "Values exceed 100% due to rounding."