What actually moves your premium

People often assume an agent has some room to move on price. We do not, and neither does anyone else. Health insurance premiums are filed with regulators before they are sold. The number you are quoted is the number, whoever quotes it.

What does move it is a short and largely fixed list.

Age

Premiums rise with age in bands rather than smoothly. Crossing into a new band changes your rate at renewal even if nothing else about you changed.

This is worth knowing for one practical reason: if you are close to a band edge, the difference between plans can look different a few months later. It is not a reason to rush a decision, but it is a reason not to be surprised by a renewal.

Where you live

Not your state — your county, and sometimes your ZIP code. Plan availability, network composition and price are all set at that level.

This is why every honest quote conversation starts by asking where you live, and why a quote given without that is not a quote. Two neighbours on opposite sides of a county line can have genuinely different options.

Tobacco use

Most individual and Marketplace plans rate for it. The definition of “use” is set by the carrier and is usually broader and longer-looking-back than people expect.

Answer it accurately. A policy issued on a wrong answer is a policy with a problem in it, and the problem surfaces at the worst possible moment — when a claim is being reviewed.

Household size and income, for Marketplace plans

For Marketplace coverage, what you pay is the premium minus any subsidy you qualify for, and the subsidy is worked out from household size and expected annual income.

Two things follow. First, an estimate is exactly that: it is reconciled against your actual income at tax time, so an optimistic guess now can become a bill later. Second, “household” is a tax concept rather than a headcount of who sleeps in the building. If your situation is at all unusual — a dependent who files separately, self-employment, seasonal income — that is worth getting right at the start.

The metal tier

Bronze, Silver, Gold and Platinum describe how the cost is split between you and the plan, not how good the plan is. A Bronze plan has a lower monthly cost and asks more of you when you use care. Platinum reverses it.

The tier is a cash-flow decision more than a quality decision, and the right answer depends on how much care you actually expect to use — which is the one input only you can supply.

What does not move it

• Which agent you use. The premium is identical whether you buy through us, through another agency, or directly from the carrier.
• How much you buy. There is no volume discount on an individual health plan.
• Negotiating. There is nothing to negotiate. Anyone implying otherwise is telling you something untrue.

Where the real savings are

Since price is fixed, the room to improve an outcome is entirely 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 of the value in this process sits. A plan that is slightly more expensive each month and covers your specialist is cheaper by the end of the year than one that does not.

A note on comparing

When you compare two plans, compare four things together rather than one: what you pay monthly, what you pay before the plan starts paying, what you pay per visit or prescription, and the most you could pay in a bad year. Any one of those on its own will mislead you.

We will lay those four out side by side for the plans we can offer. For the complete set of what exists where you live, including plans we cannot sell, use HealthCare.gov or the Medicare Plan Finder. Both are free.