What is the difference between an HMO and a PPO?

The main difference between an HMO (Health Maintenance Organization) and a PPO (Preferred Provider Organization) lies in flexibility and cost. An HMO typically requires you to choose a primary care physician (PCP) who provides referrals to specialists, and you must stay within the plan's network. PPOs offer more flexibility, allowing you to see specialists without referrals and access out-of-network providers, though at a higher cost.

How much does health insurance cost?

The cost of health insurance varies widely based on factors like plan type, coverage level, age, location, and whether it's an individual or family plan. For 2026, average monthly premiums for an individual on the Healthcare.gov marketplace could range from $300 to $600 before subsidies, while employer-sponsored plans often have lower out-of-pocket premiums due to employer contributions.

What is a deductible in health insurance?

A deductible is the amount you must pay out-of-pocket for covered medical services before your health insurance plan begins to pay. For example, if your deductible is $2,000, you are responsible for the first $2,000 of eligible medical expenses each year before your insurer starts covering costs.

Can I get health insurance if I'm self-employed?

Yes, self-employed individuals have several options for health insurance. You can purchase a plan through the Healthcare.gov marketplace, where you may qualify for subsidies based on your income. Other options include joining a spouse's employer plan, exploring professional organizations that offer group plans, or in some cases, qualifying for Medicaid.

What is an out-of-pocket maximum?

The out-of-pocket maximum is the most you will have to pay for covered medical expenses in a policy year. This limit includes your deductible, copayments, and coinsurance. Once you reach this maximum, your insurance plan pays 100% of all covered healthcare costs for the rest of the year, protecting you from unlimited expenses.

Are preventive services covered by health insurance?

Yes, under the Affordable Care Act (ACA), most health insurance plans are required to cover a range of preventive services at no cost to you. This includes annual physicals, vaccinations, and various screenings for conditions like high blood pressure, diabetes, and certain cancers. These services are typically covered even before you meet your deductible.

Health Insurance Explained 2026: Types & Costs | One…