What affects cost
Four numbers, not one.
Every plan has four numbers that decide what a year costs you. Advertising leads with the one that tells you least. Here is what each does, and what actually moves them.
We publish no figures anywhere on this site — premiums, thresholds and limits change every year, and a stale number on a licensed agency's website is worse than none. Ask us, or use the free tools below, for current amounts.
The four numbers
1
What you pay monthly
Predictable and visible. The number advertising leads with, and the least informative of the four on its own.
2
What you pay before the plan pays
The amount you cover yourself each year before most benefits begin.
3
What you pay per use
Your share of each visit, procedure or prescription after that.
4
The most you could pay
The ceiling for a year. The number people skip, and the one that matters most in the year something goes wrong.
What actually moves a premium
A short and largely fixed list. Note what is not on it: which agent you use. Premiums are filed with regulators and carry no agent mark-up, so there is nothing to negotiate and nobody who can negotiate it.
- Age
- Premiums rise in bands rather than smoothly. Crossing a band changes your rate at renewal even if nothing else changed.
- Where you live
- Not your state — your county, sometimes your ZIP. Availability, networks and price are all set at that level.
- Tobacco use
- Most individual and Marketplace plans rate for it, and the definition is usually broader than people expect. Answer it accurately: a policy issued on a wrong answer has a problem in it that surfaces at claim time.
- Household size and income
- For Marketplace plans, what you pay is the premium minus any subsidy, and the subsidy is worked out from these two. Household is a tax concept, not a headcount.
- The metal tier
- How the cost is split between you and the plan. A cash-flow decision more than a quality decision.
Where the real saving is
Since price is fixed, the only room to improve an outcome is in plan selection: matching the network to the doctors you actually use, matching the drug formulary to the prescriptions you actually take, and being honest about how much care you expect to need.
That is unglamorous, and it is where nearly all the value sits. A plan that costs slightly more each month and covers your specialist is cheaper by December than one that does not.
You may not need an agent at all
These services are free, independent, and will show you every plan in your area — including plans we cannot sell. If your situation is simple, they may be all you need.
- Medicare.gov Plan Finder — every Medicare Advantage and Part D plan where you live. Call1-800-MEDICARE, 24 hours a day, TTY 1-877-486-2048.
- Your State Health Insurance Assistance Program (SHIP) — free one-to-one Medicare counselling from people who sell nothing.
- HealthCare.gov — Marketplace plans and subsidy eligibility, plusfree local Navigators.
We list these because the alternative is you finding out later. If you call us and a free route fits better, that is what we will tell you.
Want the four numbers laid out for your situation?
One agent handles your case from the first call. We'll walk your options and tell you plainly what we can and cannot see.
No obligation. We'll tell you if a free option through Medicare.gov or HealthCare.gov suits you better. Monday to Friday, 9:00am – 5:00pm ET.