Understanding Health Insurance
Health insurance helps pay for medical expenses including doctor visits, hospital stays, prescription drugs, and preventive care. Under the Affordable Care Act (ACA), most Americans are required to have health coverage or may face tax implications.
Types of Health Insurance Plans
HMO Plans
Lower costs, requires referrals to specialists. Must use in-network providers.
PPO Plans
More flexibility to see any doctor. Higher premiums but more choice.
EPO Plans
Network-based like HMO but no referrals needed. No out-of-network coverage.
HDHP with HSA
High deductible plans with tax-advantaged Health Savings Account.
ACA Marketplace Metal Tiers
| Tier | Premium | Deductible | Coverage | Best For |
|---|---|---|---|---|
| Bronze | Lowest | Highest | 60% | Young, healthy people |
| Silver | Moderate | Moderate | 70% | Most people, subsidy eligible |
| Gold | Higher | Lower | 80% | Frequent medical use |
| Platinum | Highest | Lowest | 90% | High medical needs |
Average Health Insurance Costs 2025
| Coverage Type | Monthly Premium | Annual Deductible |
|---|---|---|
| Individual (Bronze) | $350-$450 | $6,000-$8,000 |
| Individual (Silver) | $450-$600 | $3,000-$5,000 |
| Family (Silver) | $1,200-$1,800 | $6,000-$12,000 |
| Short-Term | $100-$300 | $2,500-$10,000 |
Who Qualifies for Subsidies?
You may qualify for premium tax credits or cost-sharing reductions if:
- Your income is 100%-400% of the Federal Poverty Level
- You're not eligible for employer coverage or Medicare
- You purchase through the ACA Marketplace
- You file taxes as married filing jointly (if married)
Health Insurance for Special Groups
- Self-Employed: Deduct premiums from taxes, consider HSA-eligible plans
- Freelancers: Marketplace plans or professional associations
- Small Business Owners: SHOP marketplace or group plans
- Pre-existing Conditions: Cannot be denied under ACA
Open Enrollment 2025
November 1 - January 15 is the annual Open Enrollment Period for ACA marketplace plans. Outside this window, you need a qualifying life event to enroll.