Health Insurance: Compare Plans and Get Covered Today

What Is Health Insurance and How Does It Work?

Health insurance is a contract between you and an insurance company that pays for your medical expenses in exchange for a monthly premium. When you have health insurance coverage, you share the cost of medical care with your insurer — the insurer pays a portion of your bills after you meet your deductible, and you pay the rest up to an annual out-of-pocket maximum.

In the United States, health insurance is primarily available through four channels: employer-sponsored group plans, the ACA (Affordable Care Act) Marketplace, government programs like Medicare and Medicaid, and short-term or private plans. For adults ages 26 to 64 who do not have access to employer coverage, the ACA Marketplace is the primary source of health insurance with federal subsidies that can dramatically lower the cost of coverage.

According to the Centers for Medicare & Medicaid Services (CMS), more than 21 million Americans enrolled in ACA Marketplace health insurance plans in 2024 — a record high. The average monthly premium after subsidies was under $120 per month for eligible enrollees.

Understanding how health insurance works requires knowing a few key terms. Your premium is the monthly amount you pay to keep your health insurance active, regardless of whether you use it. Your deductible is the amount you pay out of pocket each year before your insurance starts covering costs. Your copay is a fixed amount you pay for specific services like doctor visits, while coinsurance is a percentage of costs you pay after meeting your deductible. Finally, your out-of-pocket maximum is the most you will ever pay in a single year — after that, your health insurance covers 100%.

How Much Does Health Insurance Cost in 2025?

The cost of health insurance in 2025 varies depending on your age, location, plan level, tobacco use, and income. However, for most adults ages 26 to 64 without employer coverage, health insurance through the ACA Marketplace starts at approximately $150 to $200 per month for a Bronze-tier plan before subsidies.

If you qualify for an Advance Premium Tax Credit (APTC) — the government subsidy for ACA plans — your actual monthly cost may be significantly lower. In many cases, eligible individuals can find health insurance plans for as little as $0 to $50 per month after subsidies are applied.

The income threshold for subsidies in 2025 is up to 400% of the Federal Poverty Level (FPL). For a single individual, that means income up to approximately $60,240 qualifies for some level of financial assistance. Households with incomes between 100% and 150% FPL may qualify for Silver plans with virtually zero premium.

Here is what determines the final cost of your health insurance premium:

• Age: Premiums increase with age. A 26-year-old pays roughly half the premium of a 60-year-old for the same plan.
• Location: Health insurance costs vary significantly by state and county due to local provider networks and regulations.
• Plan metal tier: Bronze plans have the lowest premiums but highest deductibles. Platinum plans have the highest premiums but lowest out-of-pocket costs.
• Tobacco use: Smokers may face premiums up to 50% higher in some states.
• Household income: The primary factor determining your eligibility for premium tax credits.

Who Qualifies for Health Insurance Coverage in 2025?

To qualify for an ACA Marketplace health insurance plan, you must meet the following basic eligibility requirements:

• You are a U.S. citizen or a lawfully present immigrant
• You are between the ages of 26 and 64 (individuals 65+ typically use Medicare)
• You do not have access to affordable employer-sponsored health insurance
• You are not currently enrolled in Medicare, Medicaid, or CHIP
• You live in the United States and are not incarcerated

To qualify for premium tax credits (subsidies) that reduce your health insurance costs, your household income must fall between 100% and 400% of the Federal Poverty Level. For 2025, that is approximately $15,060 to $60,240 for an individual and $31,200 to $124,800 for a family of four.

It is important to note that if you have a history of major preexisting conditions such as cancer, recent heart attack, or current pregnancy, ACA plans still cannot deny you coverage — but certain specialized conditions may affect which plan types are most appropriate for your situation. Our specialists can help you navigate these factors to find the most cost-effective health insurance for your specific circumstances.

To learn more about city-specific options, see our guides for health insurance in Miami, health insurance in Houston, and health insurance in Los Angeles.

Government Subsidies: Can You Reduce Your Premium to $0?

Yes — many Americans can reduce their health insurance premium to zero or near-zero through the Advance Premium Tax Credit (APTC). This federal subsidy, established under the Affordable Care Act, is calculated based on your household income relative to the Federal Poverty Level and is applied directly to your monthly premium.

Here are the 2025 income thresholds for premium tax credit eligibility:

• 1–150% FPL ($15,060–$22,590 individual): Eligible for a Silver plan with a $0 monthly premium
• 150–250% FPL ($22,590–$37,650 individual): Significant premium reduction; also eligible for Cost Sharing Reductions (CSR) with Silver plans
• 250–400% FPL ($37,650–$60,240 individual): Moderate premium tax credits
• 400%+ FPL: Some credits may still apply under the American Rescue Plan's extended subsidy provisions through 2025

According to KFF Marketplace Enrollment data, the average subsidized enrollee in 2024 paid just $111 per month after tax credits. Nearly 4 in 5 enrollees who shopped the ACA Marketplace qualified for financial assistance. If you have not checked your subsidy eligibility recently, calling a certified ACA Navigator is the fastest way to calculate your exact credit amount.

What Does Health Insurance Cover?

All health insurance plans sold on the ACA Marketplace are required by law to cover ten essential health benefits. These benefits must be included in every plan — Bronze through Platinum — regardless of your state:

1. Ambulatory patient services — outpatient care without a hospital stay
2. Emergency services — ER visits and emergency transportation
3. Hospitalization — surgeries, overnight stays, and inpatient treatment
4. Maternity and newborn care — prenatal, delivery, and postnatal care
5. Mental health and substance use disorder services
6. Prescription drugs — formulary coverage varies by plan
7. Rehabilitative and habilitative services — physical therapy, speech therapy
8. Laboratory services — blood tests, imaging, diagnostic tests
9. Preventive and wellness services — annual physicals, vaccines, screenings at no cost
10. Pediatric services — including dental and vision for children

In addition to these ten essential benefits, many health insurance plans offer extras like telehealth services, gym membership discounts, and wellness programs. Out-of-pocket costs for covered services vary by plan tier. For more detailed coverage breakdowns, see the official Healthcare.gov guide to what Marketplace plans cover.

For a detailed breakdown of plan types, visit our companion guide: Health Insurance Plans 2025: Your Complete ACA Guide.