Health insurance, explained

The most complicated insurance most Americans buy — and the one where the vocabulary itself hides the real price. This page is education only, on purpose.

Education only — for now We explain this line of insurance, but we do not offer comparisons, quotes, or lead routing for it yet. Health and disability insurance carry extra regulatory and advice-suitability rules, and we would rather publish honest education first than rush a comparison we cannot stand behind. When that changes, this note comes down and our methodology governs the comparison.

The main ways Americans get covered

Employer plans. The most common route for people under 65. KFF’s 2025 Employer Health Benefits Survey puts average total premiums at $9,325 per year for single coverage and $26,993 for family coverage — with workers contributing on average $1,440 (single) and $6,850 (family), and employers paying the rest. Your paycheck deduction is only part of the price; the employer share is also your compensation, just invisible.
ACA Marketplace plans (HealthCare.gov or a state marketplace). Individual and family plans with income-based premium tax credits for many buyers. In states using HealthCare.gov, open enrollment runs November 1 to January 15; losing other coverage, moving, marrying, or having a baby usually opens a Special Enrollment Period.
Medicare. Federal coverage mainly for people 65+, plus some younger people with disabilities. Different parts (A, B, D), different supplements (Medigap) and private alternatives (Medicare Advantage) — a maze of its own, with its own enrollment windows and late penalties.
Medicaid / CHIP. Income-based public coverage, expanded in most states. If money is tight, check this before buying anything.
COBRA. Continues your former employer’s plan for a limited time — usually at the full premium plus up to 2%, which is why it shocks people. It is sometimes still the right bridge (mid-treatment, deductible nearly met), but price it against the Marketplace before defaulting to it.
Short-term plans. Cheaper, medically underwritten, and full of exclusions — they are not ACA-compliant coverage and can reject pre-existing conditions. Know exactly what you are buying.

The terms that actually decide your cost

Premium — the monthly price of having the plan at all.

Deductible — what you pay each year before the plan starts sharing most costs.

Copay — a flat fee per visit or prescription. Coinsurance — a percentage you pay after the deductible.

Out-of-pocket maximum — the most you can pay in a year for in-network covered care. This is the number that protects you in a catastrophic year; weigh it as heavily as the premium.

Network — the doctors and hospitals contracted with the plan. Out-of-network care can cost dramatically more, or not be covered at all. HMO plans generally require in-network care and referrals; PPO plans are more flexible and more expensive; HDHPs pair high deductibles with a Health Savings Account (HSA).

Common mistakes

Comparing premiums only. A plan $80/month cheaper with a $4,000 higher deductible and a thin network is not cheaper in any year you actually get sick.
Not checking your doctors and prescriptions against the plan’s network and formulary before enrolling.
Missing open enrollment and assuming you can buy coverage whenever you feel like it — outside a Special Enrollment Period, usually you cannot.
Ignoring the out-of-pocket maximum — the real financial-risk number.
Assuming COBRA is the default after a job loss, without pricing Marketplace coverage (and its tax credits) first.
Treating Medicare as automatic and free. Parts have premiums, windows have penalties, and “free” Advantage plans carry networks and prior authorisation to weigh.

What it typically costs

Employer coverage averages are above (KFF 2025). Marketplace prices vary enormously by age, state, plan tier, and — decisively — by whether you qualify for premium tax credits, which is why honest “typical cost” numbers for individual buyers barely exist. Anyone quoting you a single national average for an individual health plan is selling something. When our comparison coverage launches, it will be built on your actual inputs, with the subsidy math shown.

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Sources (checked October 2026): KFF, 2025 Employer Health Benefits Survey (average premiums $9,325 single / $26,993 family; worker contributions $1,440 / $6,850; HDHP averages $8,620 / $25,379). HealthCare.gov — open enrollment dates for HealthCare.gov states (Nov 1–Jan 15) and glossary definitions. This page is education, not advice about your specific situation.