Health Insurance

How does health insurance split costs?

Your premium keeps coverage active. It isn't your whole health care budget. Here's how health insurance works when you use it:

• Deductible: what you pay for certain covered care before the plan starts paying, except free preventive services.
• Copay: a set amount you pay for care.
• Coinsurance: your percentage of a covered bill.
• Out-of-pocket maximum: your yearly limit for covered services. After you reach it, the plan pays all covered costs.

What's the difference between HMO, EPO, POS and PPO?

A network is the plan's group of doctors, hospitals and other providers. PPOs were the most common employer plan type in 2025, according to KFF.

• Health Maintenance Organization (HMO): generally covers only network care, except emergencies.
• Exclusive Provider Organization (EPO): covers only network care, except emergencies.
• Point of Service (POS): costs less in-network and requires a primary care referral for specialists.
• Preferred Provider Organization (PPO): allows out-of-network care without a referral, at extra cost.

Check each plan's referral rules before choosing.

What do metal levels and HSA eligibility mean?

Metal levels describe cost sharing, not care quality. HealthCare.gov's metal level page estimates plans pay these shares of covered costs:

• Bronze: 60%.
• Silver: 70%.
• Gold: 80%.
• Platinum: 90%.

These aren't your personal reimbursement rates. Actual costs vary. That guidance lists Catastrophic plans for people under 30 or with a hardship or affordability exemption, where available.

All Bronze and Catastrophic Marketplace plans, and some others, work with a Health Savings Account (HSA), which lets eligible people set aside pre-tax money for qualified medical expenses.

For 2027, standard IRS HSA-compatible high deductible plan minimum deductibles are $1,750 for self-only coverage and $3,500 for family coverage. HSA contribution limits are $4,500 and $9,000, respectively. These aren't limits for every health plan. Check contribution eligibility and tax treatment with a tax professional.

Where can you get coverage and income-based help?

Compare benefits through work with individual health insurance through the Marketplace. Medicaid and the Children's Health Insurance Program (CHIP) are other routes. Your children may qualify for CHIP even if you don't qualify for Medicaid.

HealthCare.gov's poverty level glossary lists premium tax credits for eligible households with income between 100% and 400% of the federal poverty level, an income benchmark. Credits lower premiums. Extra savings on deductibles, copays and coinsurance require a Silver plan.

That guidance says income below 138% of the federal poverty level may qualify you for Medicaid in expansion states. Apply to check eligibility rather than assuming.

When can you enroll?

HealthCare.gov's Open Enrollment for 2027 coverage starts November 1. Enroll by December 15 for January 1 coverage, or January 15 for February 1 coverage.

Outside Open Enrollment, losing coverage, moving, getting married or having a baby may qualify you for a Special Enrollment Period. Medicaid and CHIP accept enrollment year-round. Ask your employer about its benefits enrollment window.

Marketplace coverage won't start until you pay your initial premium, if you owe one.

How should you compare plans?

Estimate total yearly spending using the care and prescriptions you expect, not just premiums. Check doctors, hospitals and pharmacies in the network, prescription coverage and referral rules.

Use our plan selection guide to compare those tradeoffs. When you're ready, compare health insurance quotes alongside each plan's benefits and cost-sharing details.