What Will Health Insurance Cost You on Average?

Even though you have a short time frame to buy insurance, making the right choice is essential to avoid burdensome costs. Taking the time to find the right service provider ensures more affordable healthcare access.

Choosing the Right Options

Your employment and other circumstances determine which insurance options are available.

If Your Employer Offers Benefits

Employer-sponsored benefits are how most people receive insurance. According to KFF’s 2025 Employer Health Benefits Survey, approximately 153 million Americans rely on employer-sponsored coverage. Your employer’s insurance will likely cost less than insurance purchased from the marketplace.

One thing worth remembering is that employers pay part of the cost of employer-provided insurance. On average, employers cover 83% of the single-coverage premium and about 73% of family coverage premiums, per KFF. This cost offset isn’t available when buying on the marketplace.

If You Don’t Qualify for Employer-Provided Coverage

If your state has a marketplace, this is your go-to for insurance shopping. Going to Healthcare.gov and entering your ZIP code connects you to your state marketplace or, if unavailable, the federal marketplace established under the Affordable Care Act (ACA).

You can also buy directly from an insurance company or a private exchange. However, if you purchase from either of these sources, you won’t have access to premium tax credits. The Centers for Medicare and Medicaid Services (CMS) administers these credits, which can significantly reduce what you pay each month.

What Are the Different Types of Healthcare Plans?

You’ll likely encounter unfamiliar terms when looking for the best health insurance plan. The most typical kinds of plans are:

• Health maintenance organizations (HMOs)
• Preferred provider organization (PPO)
• Exclusive provider organization (EPO)
• Point of service (POS)

HMOs and EPOs require in-network care, except in an emergency. PPOs and POSs don’t require staying in-network but will charge more for out-of-network providers. According to KFF’s plan comparison overview, PPOs remain the most common plan type offered by employers, enrolled in by roughly 47% of covered workers.

HMOs usually require referrals, and POSs always do. PPOs and EPOs customarily don’t need referrals.

Sources: KFF Marketplace Calculator 2026; KFF Employer Health Benefits Survey 2025. Premiums are estimates for illustration and reflect silver-tier marketplace benchmarks.

Read Your Summary of Benefits

A summary of benefits that explains the plan’s coverage and costs is usually accessible through a marketplace link. The Summary of Benefits and Coverage (SBC) is a standardized document required by the ACA and regulated by the Department of Labor (DOL). There should also be a provider directory of doctors and facilities participating in your plan.

When you have insurance through your employer, you can also access a summary of benefits. However, you must contact the company benefits administrator for this information.

Think About Your Family’s Overall Needs

Consider how much and what kinds of medical treatments your family has previously received. Unexpected medical needs might arise, but keeping past trends in mind allows for better planning. The Centers for Disease Control and Prevention (CDC) reports that the average American household spends approximately $6,800 per year in out-of-pocket healthcare costs, making accurate budgeting a critical step.

Referral-Required Plans

HMO and POS plans requiring referrals require seeing your primary care physician (PCP) before visiting a specialist or scheduling a procedure. HMOs are available at a lower cost because the insurers only work with providers they contract with.

HMO and POS plans simplify everything by putting a PCP in charge of all your needs. If you have a POS plan, you can get a referral from your PCP when you see an out-of-network doctor, which lowers your costs. With an HMO, you can only get coverage out-of-network in emergency circumstances.

No-Referral Plans

Most EPOs and PPOs don’t require referrals. If you’re in a bigger urban area, EPOs can help you save money if you stay with in-network providers.

A PPO may be a better option if you live in a rural area. Remote areas with fewer providers may require going out-of-network to get care. The Health Resources and Services Administration (HRSA) notes that rural Americans face meaningfully higher rates of provider shortages, making broader network access especially important.

High-Deductible Health Plans

High-deductible health plans (HDHPs) can fall under the definition of any health plan. HDHPs have higher out-of-pocket costs while having lower premiums. For 2026, the IRS defines an HDHP as a plan with a minimum deductible of $1,650 for self-only coverage or $3,300 for family coverage, per IRS Publication 969.

These plans allow the insured to open health savings accounts (HSAs). HSA contribution limits for 2026 are $4,300 for individuals and $8,550 for families, per the IRS. These accounts make it easier to pay for health expenses and offer meaningful tax advantages, including pre-tax contributions, tax-free growth, and tax-free withdrawals for qualified medical expenses.

Check Out the Networks

The networks include facilities and doctors with contracts with insurance companies. Major national carriers like UnitedHealthcare, Anthem Blue Cross Blue Shield, Aetna, Cigna, and Humana each operate their own networks, which vary significantly by region.

Are the Networks Important?

Going to an in-network doctor costs less because of the negotiated lower rates with insurance companies. Out-of-network doctors aren’t involved in these negotiations, which likely means higher costs. The No Surprises Act, enforced by the Centers for Medicare and Medicaid Services (CMS), offers some protections against unexpected out-of-network billing in certain emergency and facility-based situations as of 2022.

How Do You Know If Your Current Doctor is In-Network?

You can ask your doctor’s office if they participate in a specific plan. Another way to see if a preferred doctor is covered is to check the provider directory. Tools like Zocdoc and insurer-specific online portals can also help you verify in-network status before you commit to a plan.

How Big Should Your Network Be?

More extensive networks with more choices can be ideal if you don’t have preferred providers. If you’re in a rural area, a more comprehensive network might give you the choice you need.

It’s a good idea to rule out plans that lack local in-network providers. The more provider options in a plan, the better. The CMS network adequacy standards set minimum requirements for how many providers must be included in marketplace plans, which is a useful benchmark when evaluating your options.

Health Plan Benefits

Your out-of-pocket costs, in addition to your premium, are essential considerations. The premium and deductible determine how much you’ll pay out-of-pocket. For 2026, the ACA caps out-of-pocket maximums at $9,200 for individual coverage and $18,400 for family coverage, per CMS.

Who Should Pay a Higher Premium?

Your out-of-pocket costs, like co-pays, are lower when you pay a higher premium. Plans with higher premiums are best for:

• People with chronic conditions
• Anyone who has an upcoming surgery
• Parents with babies or young children or expectant parents
• Anyone who takes expensive medications
• Frequent emergency room patients
• Frequent PCP or specialist patients

Who Should Pay a Lower Premium?

If you’re healthy and seldom need to see a doctor, a plan with a lower premium and higher out-of-pocket costs might be the better choice. This is especially true if you can fund an HSA alongside an HDHP to build a tax-advantaged medical reserve. Resources from NerdWallet’s health insurance cost guide and ValuePenguin’s average cost analysis offer calculators to help you model total annual costs across plan types before you decide.

Choosing health insurance is one of the most important decisions you’ll make. The more you know, the better equipped you are to choose wisely.

Frequently Asked Questions

What is the average monthly cost of health insurance in 2026?

The average monthly premium for a 40-year-old purchasing a benchmark silver plan on the ACA marketplace is $621 per month in 2026, according to KFF’s Marketplace Calculator. Employer-sponsored single coverage averages about $745 per month in total premium, with workers typically paying around $114 per month after employer contributions, per KFF’s 2025 Employer Health Benefits Survey.

How much does employer-sponsored health insurance cost per month?

For employer-sponsored single coverage, the total average premium is roughly $8,951 per year ($746/month). Workers contribute an average of $1,368 per year ($114/month), while employers cover the remaining 83%. Family coverage averages $25,572 per year total, with workers paying about $6,575 of that amount, per KFF’s 2025 Employer Health Benefits Survey.

What is the income limit to qualify for ACA premium tax credits in 2026?

Premium tax credits are available to individuals and families earning between 100% and 400% of the federal poverty level (FPL). Enhanced subsidies introduced under recent federal legislation also provide credits to households earning above 400% FPL if marketplace premiums exceed a set percentage of their income. You can check your eligibility using the Healthcare.gov subsidy tool.

What is the average health insurance deductible in 2026?

The average annual deductible for a single person on a marketplace silver plan is approximately $3,750 in 2026. For employer-sponsored plans, the average single-coverage deductible is about $1,735 per year, according to KFF’s 2025 Employer Health Benefits Survey. High-deductible health plans (HDHPs) must have a minimum deductible of $1,650 for self-only coverage to qualify for HSA pairing, per IRS Publication 969.

What is the difference between a premium, deductible, copay, and out-of-pocket maximum?

A premium is the fixed monthly amount you pay to maintain coverage. A deductible is what you pay out-of-pocket before insurance begins covering costs. A copay is a flat fee you pay per visit or service. The out-of-pocket maximum is the most you’ll pay in a plan year before insurance covers 100% of covered costs — capped at $9,200 for individuals and $18,400 for families in 2026 under ACA rules.

Is it cheaper to get health insurance through an employer or the marketplace?

Employer-sponsored coverage is almost always cheaper for workers because employers pay the majority of the premium — typically 83% for single coverage. Marketplace plans can become competitive if you qualify for significant premium tax credits. If your household income falls below 150% of the federal poverty level, you may even qualify for a $0-premium silver plan through the ACA marketplace.

What is a Health Savings Account (HSA) and who can use one?

An HSA is a tax-advantaged savings account you can use to pay for qualified medical expenses. You must be enrolled in a qualifying high-deductible health plan (HDHP) to open one. In 2026, you can contribute up to $4,300 as an individual or $8,550 as a family, per IRS Publication 969. Contributions are pre-tax, growth is tax-free, and withdrawals for medical expenses are also tax-free — a triple tax advantage.

What are the four ACA metal tiers, and how do they differ in cost?

ACA marketplace plans are categorized into four metal tiers based on how costs are split between you and the insurer. Bronze plans have the lowest premiums but highest out-of-pocket costs (insurer pays ~60%). Silver plans are mid-range and the only tier eligible for cost-sharing reductions (insurer pays ~70%). Gold plans have higher premiums but lower cost-sharing (insurer pays ~80%). Platinum plans have the highest premiums and lowest out-of-pocket costs (insurer pays ~90%).

Can I buy health insurance outside of open enrollment?

Yes, but only if you qualify for a Special Enrollment Period (SEP). Qualifying life events include losing other health coverage, getting married, having a baby, or moving to a new coverage area. SEPs typically give you 60 days from the qualifying event to enroll. Medicaid and the Children’s Health Insurance Program (CHIP) allow enrollment year-round for eligible individuals, per Healthcare.gov.

How do I know which health insurance plan is best for my situation?

Start by estimating your expected annual medical usage — number of doctor visits, prescriptions, and any planned procedures. If you use healthcare frequently, a plan with a higher premium and lower deductible (such as a gold or platinum plan) typically saves money overall. If you’re generally healthy, a lower-premium HDHP paired with an HSA may be more cost-effective. Use tools from KFF or Healthcare.gov’s plan comparison tool to model your total annual costs across options.