Health Insurance

Health Insurance

Health insurance coverage, plans, brokers, costs, and enrollment guidance for consumers and small employers.

Health insurance in the United States is confusing by design. There are multiple plan types, different cost-sharing structures, enrollment windows that open and close, and rules that change every year. About 156 million Americans get coverage through an employer, 21.3 million buy it on the ACA Marketplace, and roughly 26 million remain uninsured.

This section covers all of it. Whether you need to understand what a deductible is, compare HMO and PPO plans, figure out open enrollment deadlines, or decide whether a health insurance broker is worth talking to, start here.

Understanding Your Costs

Every health plan splits costs between you and the insurer through four mechanisms: premiums, deductibles, copays, and coinsurance. Your out-of-pocket maximum caps what you pay in a year. For 2026, ACA plans limit that to $10,150 for individuals and $20,300 for families. If those terms sound like jargon, our explainers break each one down with real dollar amounts from the KFF Employer Health Benefits Survey.

Choosing a Plan Type

The plan type you pick determines which doctors you can see, whether you need referrals, and what happens if you go out of network. PPOs offer the most flexibility (47% of workers have one). HMOs cost less but lock you into a network. EPOs sit in between. HDHPs pair low premiums with high deductibles and unlock Health Savings Accounts. We compare them all side by side so you can match a plan to how you actually use healthcare.

Enrollment and Eligibility

You can't buy health insurance whenever you want. The ACA Marketplace open enrollment for 2026 runs November 1, 2025 through January 15, 2026. Outside that window, you need a qualifying life event. Employer plans have their own schedules. Our enrollment guides cover exact dates, what counts as a qualifying event, and how to avoid paying more than you need to.

Getting Help

Licensed health insurance brokers compare plans across carriers at no cost to you (the insurer pays their commission). If the marketplace feels overwhelming, a broker can walk you through options based on your doctors, medications, and budget. We explain how brokers work and when they make sense.

Articles

cluster

Private Health Insurance: What It Is and How to Get It

About 67% of Americans have private health insurance through an employer or the marketplace. Here's how to get it and what it covers.

cluster

EPO vs PPO: Understanding the Differences

EPOs skip referrals like PPOs but don't cover out-of-network care. Here's when each plan type makes sense and what the cost difference looks like.

cluster

HMO vs PPO: Which Health Plan Is Right for You?

HMOs cost less but restrict your choices. PPOs cost more but let you see any doctor. Here's a side-by-side comparison with real cost data.

cluster

Out-of-Pocket Maximum Explained

The out-of-pocket maximum caps what you pay in a year. For 2026, it's $10,150 for individuals. Here's what counts toward it and what doesn't.

cluster

Copay vs Coinsurance: What's the Difference?

Copays are flat fees. Coinsurance is a percentage. Both come out of your pocket, but they hit your wallet differently. Here's how to tell them apart.

cluster

What Does Coinsurance Mean in Health Insurance?

Coinsurance is the percentage of a medical bill you're responsible for after your deductible. Most plans use an 80/20 split. Here's how it works.

cluster

What Does Deductible Mean? Simple Explanation

A deductible is how much you pay for medical care before your insurance starts helping. Average deductibles, how they reset, and what's exempt.

cluster

How Much Does Health Insurance Cost?

Health insurance costs $746/month for single coverage on average through an employer. Marketplace plans vary wildly. Here are the real numbers.

cluster

How Health Insurance Brokers Work and Whether You Need One

Health insurance brokers compare plans from multiple companies at no cost to you. Here's how they get paid, what they do, and when to use one.

cluster

Short-Term Health Insurance: When It Makes Sense and When It Doesn't

Short-term plans are cheap and fast to get, but they can deny you for pre-existing conditions and skip major benefits. Here's who they actually help.

money-page

Best Health Insurance Companies Compared

A comparison of the largest U.S. health insurers by coverage, cost, quality ratings, and network size. No affiliate links, just the data.

cluster

High Deductible Health Plans (HDHP): Pros, Cons and When They Make Sense

HDHPs trade higher deductibles for lower premiums and HSA eligibility. Here are the 2026 IRS thresholds and who actually saves money with these plans.

cluster

HMO Insurance: What It Means and Who It's For

HMO plans cost less but limit you to in-network doctors and require referrals. Here's how they work and whether one makes sense for you.

cluster

PPO Insurance Explained: What It Is and How It Works

PPO plans let you see any doctor without a referral, in or out of network. Here's how PPOs work, what they cost, and who they're best for.

pillar

How Health Insurance Works: A Complete Guide

How health insurance actually works, from premiums and deductibles to plan types and enrollment windows. Plain-English explanations with current numbers.

cluster

Health Insurance Open Enrollment 2026: Dates, Deadlines and What to Do

ACA open enrollment for 2026 runs November 1, 2025 through January 15, 2026. Here are the key dates, what's changing, and how to pick a plan.

cluster

What Is a Copay? Copays Explained Simply

A copay is a flat fee you pay at the doctor's office or pharmacy. Here's what typical copays cost and when you don't have to pay one.

cluster

What Is Coinsurance? And How It Affects Your Bills

Coinsurance is the percentage of a medical bill you pay after meeting your deductible. Here's how the math works and when it stops.

cluster

What Is a Deductible in Health Insurance?

Your deductible is what you pay before insurance kicks in. Here's how deductibles work, what the average amounts are, and why preventive care is free.

Research Archive

Original research from the Center for Studying Health System Change

Managed Care in California: Cost Concerns Influence Product Design

Originally published December 2009

Premium Subsidies for Employer-Sponsored Health Coverage

Originally published December 2001

Employer-Sponsored Insurance and Health Reform: Doing the Math

Originally published December 2012

Employer Health Insurance Premium Subsidies Unlikely to Enhance Coverage Significantly

Originally published December 2001

Health Coverage for the High-Risk Uninsured: Policy Options for Design of the Temporary High-Risk Pool

Originally published May 2010

Few Americans Switch Employer Health Plans for Better Quality, Lower Costs

Originally published January 2013

Lansing's Dominant Hospital, Health Plan Strengthen Market Positions

Originally published March 2011

Employers Shift Rising Health Care Costs to Workers: No Long-term Solution in Sight

Originally published May 2004

Next Steps in Incremental Health Insurance Expansions:

Originally published April 2000

Managed Care Woes:

Originally published March 2000

Public Health Departments Adapt to Medicaid Managed Care

Originally published September 1996

Competitive Albuquerque Health Insurance Market Gears Up for Coverage Boom

Originally published October 2013

Massachusetts Health Reform: Employers, Lower-Wage Workers and Universal Coverage

Originally published October 2008

Employer Wellness Initiatives Grow, but Effectiveness Varies Widely

Originally published July 2010

Managed Care Redux: Health Plans Shift Responsibilities to Consumers

Originally published March 2004

Managed Care Cost Pressures Threaten Access for the Uninsured

Originally published April 1997

Uninsured Patients, Malpractice Insurance Woes Stress Miami Health Care Market

Originally published September 2011

Perception, Reality and Health Insurance: Uninsured as Likely as Insured to Perceive Need for Care but Half as Likely to Get Care

Originally published October 2005

Community Quality Efforts Expand as Seattle Health Plan Products Evolve

Originally published September 2005

Cost Concerns Grow Despite New Health Plan Competition in Syracuse

Originally published January 2003

Federal Exchange Option and Indecision on Medicaid Expansion Create Uncertainty for Richmond, Va., Market

Originally published October 2013

Public Coverage Provides Vital Safety Net for Children with Special Health Care Needs

Originally published September 2005

Rising Costs Pressure Employers, Consumers in Northern New Jersey Health Care Market

Originally published August 2005

Market Instability Puts Future of HMOs in Question

Originally published August 1997

Some Communities Make Progress in Reducing Children's Uninsurance

Originally published April 2000

Stand-Alone Health Insurance Tax Credits Aren't Enough

Originally published July 2001

Portland, Oregon: Health Insurance Market Geared Up for National Health Reforms

Originally published July 2013

More Small Firms Offer Health Insurance but Fewer Employees Enroll

Originally published October 1999

Growth of Medicaid-Dominated HMOs

Originally published June 1996

Defining "Defined Contributions":

Originally published October 2000

Individual Insurance: Health Insurers Try to Tap Potential Market Growth

Originally published November 2009

Options for Expanding Health Insurance for People with Chronic Conditions

Originally published February 2002

Most Uninsured People Unaware of Health Care Safety Net Providers

Originally published November 2004

Denver: Competitive Insurance Market Awaits National Health Reform

Originally published June 2013

Trends in Health Insurance Coverage and Access Among Black, Latino and White Americans, 2001-2003

Originally published October 2004

HMO Model Shaken but Remains Intact

Originally published August 2005

Working Families' Health Insurance Coverage, 1997-2001

Originally published August 2002

Premium Hikes and Malpractice Insurance Disrupt Miami Health Care Market

Originally published December 2005

Wall Street Analysts Predict Several Years of Higher Health Plan Premiums

Originally published January 2005

Rough Passage: Affordable Health Coverage for Near-Elderly Americans

Originally published September 2009

For-Profit Conversions and Merger Trends Among Blue Cross Blue Shield Health Plans

Originally published January 2004

Trends in U.S. Health Insurance Coverage, 2001-2003

Originally published August 2004

Rhetoric vs. Reality: Employer Views on Consumer-Driven Health Care

Originally published July 2004

Triple Jeopardy: Low Income, Chronically Ill and Uninsured in America

Originally published February 2002

Promoting Healthy Competition in Health Insurance Exchanges: Options and Trade-offs

Originally published November 2011

Tax Credits and the Affordability of Individual Health Insurance

Originally published July 2002

Who Is Likely to Switch Health Plans?

Originally published March 2000

Employer-Sponsored Health Insurance: Down but Not Out

Originally published October 2011

Who Has a Choice of Health Plans?

Originally published July 2000

HMOs Alive and Well in Orange County

Originally published August 2005