How much does individual health insurance cost?

October 09, 2026•

10 min read

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Written byStephanie LaDuke

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Key takeaways

In 2026, average monthly premiums on the ACA Marketplace range from about $456 for bronze plans to over $625 for Silver plans. Some states have set their final 2027 rates, while others have not approved them yet.¹
The ACA’s enhanced subsidies — which had made Marketplace plans more affordable for more people — expired at the end of 2025 and were not renewed by Congress. Subsidies are still available, but they’re smaller now, and people who earn more than 400% of the federal poverty level no longer qualify for help at all.²
Your costs depend on several factors like your age, where you live, your income, plan type (like HMO or PPO), and coverage level. Knowing how these work can help you choose a better-fitting plan.³

What is individual health insurance?

Individual health insurance is health coverage that you purchase on your own, rather than getting it through an employer or government program. These plans are available through the ACA Marketplace or directly from insurance providers.

Even though it’s called “individual” insurance, these plans can cover just one person or a whole family. The term “individual” simply means the plan is bought directly by a person — not through an employer. If you include a spouse or children on the plan, it’s called a family plan —but it’s still part of the individual health insurance market.

How it compares to other insurance types

Let’s look at how individual insurance compares to other types so that you understand the difference:

Private health insurance: Includes both individual and group plans offered by private companies. It’s different from government programs.
Group insurance: Typically offered by employers, this type of insurance covers a group of employees. Employers often pay part of the monthly health insurance premium for their employees, which helps lower the cost workers’ pay out of pocket.
Other Public (Government) insurance
Includes programs like:
- Medicare – Health insurance for people aged 65 and older, or for younger people with certain disabilities or end-stage renal disease (ESRD).
- Medicaid – A joint federal and state program that provides free or low-cost coverage to low-income people and families; eligibility and benefits vary by state.
- CHIP (Children’s Health Insurance Program) – Coverage for children in families whose incomes are too high for Medicaid but too low to afford private insurance.
- TRICARE – Health insurance for active-duty service members, military retirees, and their families.
- VA Health Care – Medical coverage for eligible veterans, provided through the Department of Veterans Affairs.

Understanding the ACA Marketplace and Metal Tiers

The ACA Marketplace — also known as the Health Insurance Marketplace — is the official place to shop for individual health insurance plans under the Affordable Care Act (ACA). It was created to make it easier for people to compare and buy health insurance, especially if they don’t get coverage through a job.

The ACA Marketplace offers health insurance plans grouped into four levels called metal tiers.⁴ Each tier differs in how costs (including deductibles, copays, and coinsurance) are shared between the individual and the insurance company.

Let’s look at the differences in each tier, below.

Individual health insurance Metal Tiers guide

Now let’s take a closer look at what each tier could mean for you.

Metal Tiers: A closer look

Tier:	Insurer pays:	*You Pay (through deductibles, copays, and coinsurance***):	*Additional notes:*	Might be ideal if:
BRONZE	60%	40%	Lowest monthly premiums, but high deductibles.	You don’t expect to have many medical needs.
SILVER	70%	30%	The only plan that unlocks extra financial help (cost-sharing reductions or CSRs) for low-to moderate-income enrollees.	You may qualify for lower deductibles and copays if your income is moderate.
GOLD	80%	20%	Higher premiums, but lower out-of-pocket costs for ongoing care.	You require frequent medical care.
PLATINUM	90%	10%	Highest monthly premiums; best for managing chronic conditions or frequent care needs.	You want the lowest out-of-pocket costs.

2026 Premium and deductible overview

The table below reflects finalized 2026 Marketplace data — the most recent full-year figures available. According to HealthCare.gov, plans and prices for 2027 will be available for preview shortly before Open Enrollment starts on November 1.⁵

Tier	Average monthly premium cost	Average deductible (amount you need to pay out of pocket before your insurance pays)
BRONZE	~$456 (lowest-cost)¹	~$7,476⁶
SILVER	~$611 (lowest-cost) / ~$625 (benchmark)¹	~$5,304⁶
GOLD	~$615 (lowest-cost)¹	~$1,722⁶
PLATINUM	Usually the highest; KFF does not report a 2026 national average^1,3	Usually the lowest; KFF does not report a 2026 national average^1,3]

Note: These figures are averages and can vary based on location, age, and other factors. Figures reflect gross (pre-subsidy) premiums for a 40-year-old, and average deductibles by tier. Platinum plans make up a small share of Marketplace enrollment and are not consistently reported in national averages, but they remain the highest-premium, lowest-deductible tier.¹

2027 outlook: what’s changing for Marketplace coverage

Although rates are not final in every state, premiums may rise again in 2027.

Key factors include rising medical and prescription drug costs — including GLP-1s and other specialty medications —and changes in enrollment after the enhanced subsidies expired. In 2026, 87% of Marketplace enrollees received a premium tax credit, which helped lower their monthly costs.² However, people earning more than 400% of the federal poverty level — $62,600 for one person in 2026 — generally no longer qualify for federal premium assistance.

What are Catastrophic plans?

Although Catastrophic health insurance plans aren’t part of the Bronze thru Platinum “metal tier” structure, they’re another option for individual health insurance on the ACA Marketplace.

Here’s what makes them different:

Catastrophic health insurance is available only to people under 30 or those who qualify for a hardship exemption (where someone faced a difficult life situation or financial circumstance that made it hard to afford regular health insurance).
These plans offer very low monthly premiums but have extremely high deductibles (around $9,450 in 2025).
They cover essential services after the deductible is met and include a few free doctor visits per year.
They may be a good fit if you’re young, healthy, and looking only for financial protection in case of serious illness or injury — but they don’t qualify for subsidies. Because of this, Bronze plans are often a better value for many people, as they offer the lowest-cost option among the plans that do qualify for subsidies.

Understanding plan types: HMO, PPO, EPO, POS, and HDHP

Now let’s look at different individual health insurance plan types underneath each tier. When choosing a health plan, you’ll not only pick your metal tier (Bronze, Silver, Gold, or Platinum) but also a plan type, such as Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO), Point of Service (POS), or High Deductible Health Plan (HDHP). These plan types affect your monthly premium, out-of-pocket costs, and how you access care.

What are the key differences between plans?

Premiums: How much you pay each month

Plans that offer more flexibility, like PPOs, usually have higher monthly premiums.
HDHPs often have lower monthly premiums but come with higher out-of-pocket costs.
Premiums may also be lower in some plans, like HMOs or EPOs, that limit you to smaller provider networks.

Out-of-pocket costs: What you pay to get care

Out-of-pocket costs include things like premiums, deductibles, copayments, and coinsurance — what you pay before and after insurance kicks in.
HMO and EPO plans often have lower deductibles but may require you to pay more out-of-pocket if you go outside the network.
HDHPs have high deductibles but can be paired with a Health Savings Account (HSA) to help offset costs with tax-free savings.

Provider access: Who you can see and how

This refers to which doctors, hospitals, and specialists you can visit under your plan.
HMO plans typically require you to stay in-network and get a referral from a primary care doctor to see a specialist.
PPOs and POS plans usually allow out-of-network care, though you’ll pay more for it.

See the chart below for a quick reference guide of each plan type and what it offers.

Individual health insurance plan guide:

Plan Type	Monthly Cost	Network Access	Referrals Needed?	Out-of-Network Coverage	Special Features
HMO	Lower	In-network only	Yes	No	Lower cost, but limited flexibility
PPO	Higher	In-and out-of-network	No	Yes	Flexible access to care
EPO	Moderate	In-network only	No	No	No referrals, but no out-of-network coverage
POS	Moderate	In-and out-of-network	Yes	Limited	Hybrid of HMO and PPO
HDHP	Lower	Varies by plan	Varies	Varies	High deductible, HSA-eligible

*Note: Not every plan type is available under each metal tier or in every location. Availability depends on your state, insurer options, and local provider networks.

What else affects the cost of individual health insurance?

Along with the metal tiers and plan types, several other factors can greatly impact what you pay for health insurance:

Key factors that may affect your premium:

Age – Older adults may pay up to three times more than younger individuals for the same plan.
Location – Healthcare costs and insurer competition vary by region, so where you live directly affects pricing.
Tobacco use – Smokers often face higher premiums due to increased health risks.
Income – If you qualify for ACA subsidies, your monthly premium could be reduced significantly, especially for Silver plans.

Also, insurer choice matters — some insurers may offer larger networks or more competitive prices even within the same plan type and tier.

Health insurance examples: How costs can vary

To make these options easier to understand, here are some combinations that show how tier and plan type can affect your costs.

Example of plan cost variances

Tier & Plan Type	Estimated Monthly Premium	Estimated Deductible
Bronze HMO	$380	$7,400
Silver PPO	$530	$4,000
Gold EPO	$510	$1,500
Platinum POS	$550	$800

*Note: Actual prices will vary.

Example Scenarios:

If you’re focused on low premiums and don’t expect frequent medical visits, a Bronze HMO might work well — just be prepared for a higher deductible.
If you want to keep your doctor or need specialist care without referrals, you might prefer a PPO, even if it costs a bit more each month.
If you manage a chronic condition or anticipate regular healthcare needs, a Gold or Platinum plan with a lower deductible and broader provider access might save you money in the long run.
If you’re young and healthy, a HDHP paired with an HSA can be a smart option that gives you financial protection and tax benefits.

How to choose the right individual health insurance plan for you

With so many variables, it’s important to choose a plan that matches your personal health, finances, and preferences:

Consider your expected medical needs. Do you visit doctors often, take regular prescriptions, or just want coverage in case something unexpected happens?
Think about your budget. Can you handle a higher deductible in exchange for lower monthly premiums — or would you rather pay more each month to reduce out-of-pocket costs later?
Evaluate your preferred level of provider flexibility. Are you okay staying in-network and getting referrals, or do you want more freedom to choose out-of-network providers as well?

Pro Tip: During Open Enrollment, take time to compare individual health insurance plans carefully. Look beyond the monthly premium — also review deductibles, networks, and what’s covered.

Final review: How much does individual health insurance cost?

Let’s look at the key takeaway points from this article:

In review, the cost of individual health insurance depends on several factors, including your plan’s metal tier, the type of plan you choose (like HMO or PPO), your age, location, and whether you qualify for subsidies.
By understanding your options and comparing plans during Open Enrollment, you can find coverage that fits both your health needs and your budget.

Though the answer to how much individual health insurance costs varies greatly, eHealth offers smart tools that make it easier than ever to compare and save today.

Sources:

MMR 4649-2026