Ready to Sign up for Health Insurance? 8 Important Questions Answered Here!

November 1st kicks off open enrollment for the Health Insurance Marketplace — sometimes known as Obamacare. For those without group insurance, it’s the time period where you can sign up for a comprehensive individual health plan and apply for subsidies to help pay for it.

The federal government runs the Healthcare.gov marketplace where consumers can see and sign up for private insurance plans. Many states run their own state-branded marketplaces, but if you don’t know what the website is for your state, you can go to Healthcare.gov and it will direct you to the right place.

Until the Affordable Care Act (ACA) passed in 2010, many people without employer-provided insurance were uninsurable. It was perfectly legal for insurance companies to deny coverage or charge higher premiums to applicants who had a pre-existing health condition. And that turned out to be a lot of people. In 2018, KFF reported that pre-ACA, more than a quarter of adults under age 65 “had declinable pre-existing conditions that would have made them uninsurable.” However, since the ACA became effective, more people have some type of health insurance than ever before.

If you’re interested in signing up for health insurance through the Healthcare.gov marketplace or your state marketplace during open enrollment, here’s everything you need to know.

Your 8 Most Important Health Insurance Questions Answered

Open enrollment begins on November 1. If you sign up by December 15, coverage starts on January 1. Open enrollment ends on January 15. (A few states have slightly different starting or ending dates.)

2. How much can I expect to pay for health insurance?

A lot of factors go into estimating monthly insurance premium costs for families and individuals, including their ages and location. But if you go to HealthCare.gov’s See Plans & Prices page and answer a few questions, you will see your estimated costs and options.

If you’re already enrolled in an ACA plan, simply log in to your marketplace account, answer a few questions, and see the options and prices.

3. What is the difference between gold, silver, bronze, and platinum plans?

There are five categories of health insurance plans. Here’s a pretty basic breakdown.

Platinum

Monthly Premium: Highest
You pay: About 10% of your medical costs on average
Cost of deductibles: It depends on a variety of factors, but it can be $0
This might be a good plan for you if: You use your health insurance frequently and you can afford a high monthly premium.

This plan covers the most medical expenses up front, but also costs the most per month. If you or someone in your family has a chronic illness or requires ongoing medical care and uses prescriptions, you may want to consider this tier. But you’ll still want to run some numbers and consider how much more you’d pay per month vs. how much deductible you’d pay in a cheaper plan to see if this type of plan would pay off.

Gold

Monthly Premium: High
You pay: About 20% of your medical costs on average
Cost of deductibles: Not as low as Platinum, but lower than Silver and Bronze
This might be a good plan for you if: You need a lot of medical care and you can afford a high monthly premium.

This can be a good plan if you or a family member requires more than the standard amount of medical care and has multiple pharmacy prescriptions. But you’ll still want to run some numbers on how much total you might spend per year (for premiums plus deductibles for your care) to see if a cheaper plan might come out cheaper overall.

Silver

Monthly Premium: Moderate
You pay: About 30% of your medical costs on average
Cost of deductibles: Moderate. In 2025, the average deductible for this tier was under $5,000, without subsidies.
This might be a good plan for you if: You see your medical provider more than once a year, or you have one or more medical specialists.

If you’re healthy overall, but plan to see one or more specialists, or if you think you’ll need treatment from an emergency department, a Silver plan can help offset expensive medical bills and prescriptions. However, there are complications too long to go into here that raised the prices of Silver plans several years ago, so unless you qualify for an extra type of subsidy called cost-sharing reductions, you may be better off getting a Gold or Bronze plan instead.

Bronze

Monthly Premium: Lowest
You pay: About 40% of your medical costs on average
Cost of deductibles: Highest
This might be a good plan for you if: You’re in good health and you don’t plan to see your doctor more than once a year for recommended preventive care, or maybe just a couple of visits. You don’t use prescriptions, or only occasionally or only cheap generics.

If you’re in good health and not accident-prone, Bronze is a good health insurance plan that will cover any unexpected or emergency high expenses after you pay the deductible. (And of course, preventive services are free up front, like on all ACA health plans.)

Catastrophic Plan

Monthly Premium: Very low
You pay: After deductible, $0
Cost of deductibles: Very high. The deductible for 2026 is $10,600 for individuals and $21,200 for families.
This is a good plan for you if: You’re young and in very good health. You only see a medical provider for preventive care, you don’t see a medical specialist, and you don’t need many, if any, prescription medications.

If you’re under 30, in very good health, and rarely need to see a doctor or specialist, you may want to consider a catastrophic healthcare plan. Note that with these plans, besides needing to be under 30 to qualify (unless you receive a hardship exemption), you can’t get subsidies with them.

You can get more information about metal category plans here.

4. I see my doctor once a year for checkups. Should I get an expensive healthcare plan?

The ACA requires health insurance companies to cover preventive health services. So if you only plan to go to the doctor once a year for a checkup, then you don’t have to pay top dollar for a health plan. Well visits and physical exams are fully covered (one free visit per year) on all plans. Screenings for certain common diseases and infections are also covered for no cost on all plans, including mammograms and blood lab tests for conditions like high cholesterol and diabetes. See more information about preventive care services here.

Maybe, but you need to know some things first. If you get insurance through work, your health insurance is fully or partially paid for by your employer. If you enroll in a Marketplace plan, your employer does not have to help you pay for it (unless your employer offers an ICHRA where they pay for employee’s individuals plans). And if you turn down job-based coverage, you won’t qualify for premium tax credits (subsidies) that could drastically lower your premium costs, unless your employer’s coverage is calculated to be “unaffordable” for you.

If the insurance offered at your job does not meet the minimum value standard (if it does not cover at least 60% of the total cost of medical services), or it’s unaffordable, then you can consider a plan from the marketplace and likely qualify for subsidies. You can go to HealthCare.gov to get more information about comparing your employer-based health care benefits to the Marketplace.

Yes. Depending on your situation, you may be able to sign up for a more affordable health plan outside the marketplace — even ACA-compliant plans. However, many of these plans are not regulated by the ACA. This means some of them provide less coverage and use medical underwriting to determine your costs.

For a plan not on the marketplace that covers everything marketplace plans do and has the same protections, it will probably cost very similar to an equivalent marketplace plan, unless it’s a Silver plan for reasons stated above (they can be much cheaper off the marketplace). However, only plans offered through the marketplace are eligible for subsidies if your income changes.

7. My premiums may not go up that much, but I’ll still get expensive surprise bills, right?

You shouldn’t! New laws such as the Transparency in Coverage Rule, Hospital Price Transparency Rule, and the No Surprises Act provide ways to access pricing information before receiving care. Additionally, each state has legislation aimed at price transparency.

One of these laws, the No Surprises Act, protects those with job-based or individual health insurance plans (not public health plans like Medicaid or Medicare). It makes it illegal for providers to bill for out-of-network services unless the patient specifically agrees to the service. This pertains to situations such as if you have to go to the ER for an X-ray and you pay your co-pay and think you’re done, then you receive another bill a few months later because the radiologist was out-of-network. Additionally, the No Surprises Act provides protections for uninsured patients.

Check out these articles for more details from Crush Medical Debt and Investopedia.

8. I have insurance. What do I care what a test or procedure costs?

Fair question. It turns out that some hospital services are cheaper if you don’t use your insurance! The New York Times published an article about hospital transparency, and what they discovered was incredible. A colonoscopy at a Mississippi hospital cost $2,144 with an Aetna insurance plan. For uninsured patients, the same procedure costs $782. The hospital doesn’t want you to know this because they want to bill the higher amount. And insurance companies don’t want this information out there because it would give consumers more power to compare health insurance companies and plans. Expensive services, whether you personally pay the full price or not, raises overall healthcare system costs for everyone.

Read Decoding Health Insurance

To better understand health insurance and the U.S. health care system, check out our book Decoding Health Insurance and the Alternatives: Options, Issues, and Tips for Saving Money. It has detailed, easy-to-read information about individual insurance and other types of plans, plus tips for buying health insurance and saving money on all types of health care.

Ready to Sign up for Health Insurance? 8 Important Questions Answered Here!