That “10% Health Insurance Increase” Is a Lie — Here’s What It’s Really Costing Families

Key Takeaways

• The widely reported 10% health insurance rate increase is an average and does not reflect what many families are actually paying.
• Many individuals and families are experiencing 30%–100% premium increases, often due to subsidy loss, plan restructuring, or regional pricing.
• PPO health insurance plans have become significantly more expensive, while HMO plans offer substantial savings for many households.
• Moving from a Gold or Platinum plan to a Silver plan can lower monthly premiums without drastically reducing coverage.
• In California, Covered California remains the most affordable option for those who qualify for subsidies.

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If you’ve been told that health insurance rates only increased by “about 10%” this year, you’re not alone — and unfortunately, that number is deeply misleading. While official reports may show an average increase across California and nationwide, the real-world impact on families and individuals tells a very different story.

For many people, premiums didn’t rise 10%. They rose 30%, 50%, or even doubled.

As licensed insurance professionals working daily in both the under-65 market and Medicare, we see these increases firsthand. This isn’t theoretical. These are real families calling us because their coverage has gone from manageable to unaffordable almost overnight.

Why the “10% Increase” Doesn’t Reflect Reality

That 10% figure is an aggregate average — calculated across all counties, all insurance carriers, and all plan types. It does not account for how rate changes hit individuals based on age, household size, location, or subsidy eligibility.

In fact, many Californians lost subsidies through Covered California this year, which caused premiums to spike dramatically. In our own office, we’ve seen families paying $8,000 to $12,000 more per year for the same level of coverage.

When it comes down to it, averages don’t pay the bills. Dollars and cents do.

Under Age 65: Where Real Savings Are Found

If you’re insured through the individual or family market, there are two primary levers that can reduce your premium:

1. Adjusting Your Metal Tier
If you’re on a Gold or Platinum plan, moving down to Silver can often save hundreds of dollars per month. Silver plans remain the most balanced option for many households, while Bronze plans can work for those who understand and accept higher deductibles.

The key is strategy — not guesswork.

2. PPO vs HMO: The Biggest Cost Divider
PPO plans have effectively become a luxury item. While they offer flexibility, they come at a steep price. In many cases, families switching from PPO to HMO save $10,000–$12,000 per year.

Yes, HMOs require coordination and sometimes changing doctors — but for many households, the savings far outweigh the inconvenience. With proper guidance, this transition can be smooth and predictable.

Medicare Changes Are Forcing Decisions Too

The Medicare market has also shifted significantly. Many PPO Advantage plans have exited California counties altogether. Insurance companies don’t pull plans unless they’re losing money — and that reality has left many seniors scrambling.

In these cases, the options typically come down to:

• Moving into an HMO Advantage plan, often with little to no monthly premium, or
• Transitioning to Medigap, which offers broader access but comes with higher monthly costs that increase with age

Neither option is “better” universally — it depends on your doctors, budget, and long-term health needs.

Why Working With an Agent Matters

Health insurance pricing is fixed. You don’t pay more by working with an agent — but you gain expertise, advocacy, and clarity.

Our role is to:

• Understand carrier networks and doctor access
• Identify realistic savings opportunities
• Prevent costly mistakes
• Help you adapt as healthcare rules and pricing continue to change

And we do this at no cost to you.

That 10% number may look reasonable on paper, but for many families, it’s simply not true. If your health insurance feels unaffordable or confusing, it’s time to look at your options with someone who knows the market and works for you — not the insurance company.

If you need help reviewing your coverage or lowering your costs, reach out to us here.

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