Wealthy PotAverage Health Insurance Cost: Three Honest Numbers
There is no single average cost of health insurance in America, and any page that gives you one number is hiding something. Employer coverage averaged $9,325 a year for one person and $26,993 for a family in 2025, per the KFF Employer Health Benefits Survey. Marketplace plans averaged $619 a month before subsidy and $178 after for the 2026 plan year, per CMS. Households themselves paid an average of $4,055 in 2024, per the Bureau of Labor Statistics. Those three numbers are all correct, they all measure something different, and this page separates them.
Table of Contents
The Short Answer
- Employer coverage, 2025: the full premium averaged $9,325 a year for single coverage and $26,993 for family coverage. Workers paid $1,440 and $6,850 of that. Employers paid the rest.
- The gap is the story. The employer put in $7,884 for single coverage and $20,143 for family coverage. A worker with family cover sees $571 a month leave their payslip while the plan actually costs $2,249 a month.
- Marketplace coverage, 2026 plan year: the average selected plan cost $619 a month before the advance premium tax credit and $178 after it. 87% of enrollees got a credit.
- The enhanced ACA subsidies expired on 31 December 2025. For 2026 and 2027 the ordinary premium tax credit rules are back, including the cap at 400% of the federal poverty line.
- Households, 2024: the average consumer unit spent $4,055 on health insurance out of its own pocket, about $338 a month, and $6,197 on healthcare overall.
- Age, location and tobacco use are the only personal factors that may legally change an individual or small group premium. Your medical history may not.
Three Questions Hiding in One
"What does health insurance cost on average" is really three questions asked at once, and each has its own official answer from its own body, for its own year.
| Question | Who measures it | Latest data year | Unit counted |
|---|---|---|---|
| What does a job-based plan cost? | KFF Employer Health Benefits Survey | 2025 | One policy, single or family |
| What do people buying their own coverage pay? | CMS, Health Insurance Exchanges Open Enrollment Report | 2026 plan year | One person's plan selection |
| What does a household actually hand over? | BLS Consumer Expenditure Survey | 2024 | One household, all its members |
Mixing them produces nonsense. The employer figure counts money you never see. The marketplace figure counts one person, not a household, and its headline exists in two versions that differ by hundreds of dollars a month. The household figure averages in every family that pays nothing. Keep them apart and each one becomes useful.
Employer Coverage: The Real Price
KFF puts the number of people under 65 covered through a job at 154 million, which makes this the figure most readers need. KFF has run the Employer Health Benefits Survey for 27 years and conducts it directly, interviewing 1,862 public and private firms for the 2025 edition. It is the authoritative annual measure of what job-based coverage costs.
| Year | Single: worker | Single: employer | Single: total | Family: worker | Family: employer | Family: total |
|---|---|---|---|---|---|---|
| 2020 | $1,241 | $6,250 | $7,491 | $5,567 | $15,851 | $21,419 |
| 2023 | $1,409 | $6,997 | $8,406 | $6,519 | $17,425 | $23,944 |
| 2024 | $1,408 | $7,505 | $8,913 | $6,366 | $19,219 | $25,586 |
| 2025 | $1,440 | $7,884 | $9,325 | $6,850 | $20,143 | $26,993 |
The single premium rose 5% over the year and the family premium 6%. KFF sets that against a 4% rise in workers' wages and 2.7% inflation. Stretch the window and the pattern is less dramatic than it feels: over five years the family premium rose 26%, while wages rose 28.6% and prices rose 23.5%.
Averages hide a lot here. Three splits worth knowing:
- Plan type. A high-deductible plan with a savings option averaged $8,620 single and $25,379 family. A PPO averaged $9,818 and $28,272.
- Firm size. Single premiums are similar at small and large firms ($9,211 versus $9,361), but family premiums are lower at firms with 10 to 199 workers ($26,054 versus $27,280).
- Who the firm employs. Firms where at least 35% of workers are 50 or older averaged $27,699 for family coverage against $26,332 elsewhere.
Your Payroll Deduction Is Not the Price
This is the single most useful thing on this page. Almost nobody with job-based coverage knows what their plan costs, because the payslip only shows their share. In 2025 covered workers paid on average 16% of the single premium and 26% of the family premium. The employer paid the other 84% and 74%.
| Coverage | What you see monthly | What the employer adds monthly | What the plan costs monthly |
|---|---|---|---|
| Single | $120 | $657 | $777 |
| Family | $571 | $1,679 | $2,249 |
That employer contribution is not a gift. It is part of what it costs to employ you, and the federal government measures it as such. In the Bureau of Labor Statistics survey of employer compensation costs, health insurance cost private-sector employers $3.48 per hour worked in June 2026, which was 7.4% of total compensation. In state and local government it was $7.61 an hour and 11.4% of compensation. Wages and salaries account for 70.0% of private-sector compensation; the rest is benefits, and health insurance is the largest single line inside them.
Two practical consequences. First, when you compare a job offer, an employer paying the full single premium is handing you something close to $7,900 a year that never appears in the salary figure. KFF found that 29% of covered workers at firms with 10 to 199 workers are in a plan where the employer pays the entire single premium, against only 7% at larger firms. Second, if you are weighing leaving a job for self-employment, the marketplace premium you will be quoted is closer to the whole $777 or $2,249 a month than to the payroll deduction you are used to.
The smaller the employer, the heavier the family bill. Workers at firms with 10 to 199 employees contributed an average of $8,889 a year for family coverage, against $6,227 at firms with 200 or more. Eleven percent of all covered workers, and 28% at the smaller firms, pay $12,000 or more a year for family coverage.
What You Pay After the Premium
The premium buys access, not care. In 2025, 88% of covered workers with single coverage had a general annual deductible, and it averaged $1,886. Where you work changes that more than anything you choose: the average deductible was $2,631 at firms with 10 to 199 workers and $1,670 at larger firms.
| Cost-sharing feature | 2025 average or distribution |
|---|---|
| General annual deductible, single coverage | $1,886 |
| Share of covered workers with a deductible of $2,000 or more | 34% (53% at firms with 10 to 199 workers) |
| Copay, primary care visit | $27 |
| Copay, specialist visit | $45 |
| Coinsurance, primary care and specialist | 19% |
| Out-of-pocket limit of $2,000 or less | 12% of covered workers |
| Out-of-pocket limit above $6,000 | 21% of covered workers |
There is a hard ceiling on this, set by federal rule rather than by your plan. For the 2026 plan year the maximum annual limitation on cost sharing is $10,600 for self-only coverage and $21,200 for everything else, finalised by HHS in June 2025. That is the most an in-network year can cost you on top of premiums under a plan subject to the rule. It is also a reminder of why the deductible number alone is a poor guide to risk.
If your plan is a high-deductible one, the deductible is not purely a loss. It is the entry ticket to a health savings account, which is the only account in the tax code with a deduction going in, tax-free growth, and tax-free withdrawals for medical costs. Whether that trade is worth taking depends on your own cash flow, which we work through in is an HSA worth it and HSA vs FSA.
Marketplace Coverage: Sticker and Net
If you buy your own coverage through the ACA marketplace, the published premium and what you actually pay can differ by more than three to one. Both are real numbers and CMS publishes both. Quoting only one of them is how most pages go wrong.
For the 2026 plan year, across every state and the District of Columbia, 23.1 million people selected or were automatically re-enrolled in a plan. CMS reports the average monthly premium of those selections as $619 before the advance premium tax credit and $178 after it.
| Measure | 2025 plan year | 2026 plan year |
|---|---|---|
| Average monthly premium before APTC | $619 | $619 |
| Average monthly premium after APTC | $113 | $178 |
| Share of consumers selecting a plan with APTC | 92% | 87% |
| Share paying $10 or less a month after APTC | 42% | 34% |
| Total plan selections | 24.3 million | 23.1 million |
On the HealthCare.gov platform alone, 29% of consumers selected a plan costing $0 a month after the credit, and 54% paid $50 or less.
Read the after-subsidy row carefully, because it is doing several jobs at once. It averages across everyone who picked a plan, including the 13% who received no credit at all and paid the full premium. CMS publishes a narrower figure for consumers who did receive a credit on HealthCare.gov in both years: for them, the after-credit premium rose by $15 a month between 2025 and 2026, against an average rise of $36 across state-based exchanges.
Two things changed alongside the money, and CMS reports both. The share of enrollees picking silver plans fell from 56% to 43%, with bronze and gold taking up the difference, and 43% of HealthCare.gov consumers enrolled in an HSA-eligible plan, up from 2% a year earlier, because from 2026 every bronze and catastrophic plan qualifies. Enrolment fell by 1.2 million. CMS does not break the $619 gross average into a price effect and a plan-mix effect, so neither do we.
The Subsidy Rules Changed for 2026
Between 2021 and 2025 the premium tax credit was temporarily more generous than the Affordable Care Act originally wrote it. That regime has ended, and anyone budgeting for individual coverage needs to know it.
The enhanced credits came from the American Rescue Plan Act of 2021 and were extended by the Inflation Reduction Act of 2022. The extension was written with a date in it. Section 12001 of that Act replaced the words "in 2021 or 2022" with "after December 31, 2020, and before January 1, 2026", both for the enhanced payment schedule and for the rule allowing a credit to households above 400% of the federal poverty line.
Nothing has replaced it. HHS states the position in its own rulemaking, in the Notice of Benefit and Payment Parameters for 2027 published in May 2026:
"Additionally, many resources needed to implement and oversee administration of the enhanced subsidies codified under the ARP, and later extended under the Inflation Reduction Act of 2022, are no longer needed since they expired at the end of 2025."
The IRS guidance confirms it in the most concrete way possible. Each year the IRS publishes the applicable percentage table that sets the share of income a household is expected to contribute before a credit kicks in. Here is what it says for 2026 and 2027.
| Household income as a percentage of the federal poverty line | 2026, initial to final | 2027, initial to final |
|---|---|---|
| Less than 133% | 2.10% | 2.15% |
| At least 133% but less than 150% | 3.14% to 4.19% | 3.23% to 4.3% |
| At least 150% but less than 200% | 4.19% to 6.60% | 4.3% to 6.78% |
| At least 200% but less than 250% | 6.60% to 8.44% | 6.78% to 8.66% |
| At least 250% but less than 300% | 8.44% to 9.96% | 8.66% to 10.22% |
| At least 300% but not more than 400% | 9.96% | 10.22% |
| Above 400% | No band. No premium tax credit. | |
Three things follow, and they are worth being blunt about.
- The income cliff is back. A household one dollar above 400% of the poverty line gets no credit at all. Using the 2025 poverty guidelines, which govern 2026 coverage, 400% works out at $62,600 for one person and $128,600 for a household of four in the 48 contiguous states and Washington DC. Alaska and Hawaii have higher thresholds.
- Nobody at any income is expected to pay nothing. Under the enhanced rules the lowest band was zero. For 2026 the floor is 2.10% of income.
- The top band is close to a tenth of income. A household between 300% and 400% of the poverty line is expected to contribute 9.96% of income towards a benchmark plan in 2026, rising to 10.22% in 2027.
These are the rules as they stand on 30 September 2026. Congress can change them, and the subject has been live. We are not forecasting what it will do, and we will not publish a projected 2027 net premium.
What May Legally Change Your Premium
In the individual and small group markets the list of things an insurer may price on is short, closed, and written into federal regulation. This is not a general principle about health insurance, it is a specific rule with a citation.
45 CFR 147.102 says the rate may vary only by whether the plan covers an individual or a family, by rating area, by age, and by tobacco use, and then adds the closing sentence that does the work:
"The rate must not vary with respect to the particular plan or coverage involved by any other factor not described in paragraph (a)(1) of this section."
The limits on the two personal factors are numerical:
- Age may not vary the rate by more than 3:1 for people aged 21 and over. A 64 year old may pay at most three times what a 21 year old pays for the same plan.
- Tobacco use may not vary the rate by more than 1.5:1, and the regulation defines it as "use of tobacco on average four or more times per week within no longer than the past 6 months", excluding religious or ceremonial use. States may narrow these bands further, so what applies to you depends on where you live.
- Rating area is set by your state, using counties, three-digit zip codes or metropolitan areas. In the individual market it follows the primary policyholder's address.
What is absent from that list matters more than what is on it. Your sex, your occupation, your claims history and your medical conditions may not change the price. Separately, 45 CFR 147.108 states that a plan or issuer "may not impose any preexisting condition exclusion", and the regulation's own worked example makes the point plainly: denying an application because a pre-enrollment physical found type 2 diabetes is a prohibited pre-existing condition exclusion. Both rules descend from sections 2701 and 2704 of the Public Health Service Act, added by the Affordable Care Act.
One boundary to keep straight. The rating rule in 147.102 applies to the individual and small group markets. It does not govern large-group or self-funded employer plans, and 67% of covered workers are in a self-funded plan. The ban on pre-existing condition exclusions in 147.108 is broader and reaches group health plans as well.
What Households Actually Spend
The third measure counts households rather than policies. The Bureau of Labor Statistics Consumer Expenditure Survey found the average consumer unit spent $4,055 on health insurance in 2024, about $338 a month, inside total healthcare spending of $6,197.
| Item | Average per consumer unit, 2024 | Share of all spending |
|---|---|---|
| Health insurance | $4,055 | 5.2% |
| Medical services | $1,252 | 1.6% |
| Drugs | $658 | 0.8% |
| Medical supplies | $233 | 0.3% |
| Healthcare, total | $6,197 | 7.9% |
| Average annual expenditures, all items | $78,535 | 100% |
Healthcare spending was almost flat in 2024, rising 0.6%, and the health insurance line rose 0.1%. Set against the KFF and CMS figures, that stillness looks odd until you see what the BLS number is.
Do not compare $4,055 with $26,993. The two are built differently:
- BLS defines an expenditure as "the actual financial obligation incurred for goods or services acquired by the CU from a source outside the CU". Your employer's $20,143 is not an obligation your household incurred, so it is not in the $4,055. Neither is the part of a marketplace premium paid by a tax credit.
- The figure is a mean across all consumer units, including everyone on Medicaid or veterans' coverage who pays no premium at all.
- It sweeps in things the other two measures exclude, notably Medicare Part B premiums and Medicare supplement policies held by retired households.
Use the KFF number to understand what a job-based plan costs, the CMS numbers to understand what you might pay on the marketplace, and the BLS number when you are sizing up national household budgets. For your own budget, the health insurance line belongs alongside the other fixed monthly bills in average monthly expenses, and it is worth noticing that in the same 2024 survey the average household spent $4,055 on health insurance against $1,993 on vehicle insurance.
Sources & Methodology
- KFF, 2025 Employer Health Benefits Survey, published 22 October 2025: every employer-coverage figure on this page, including the premiums, worker and employer contributions, contribution percentages, deductibles, copays, out-of-pocket limits, plan mix and the 154 million covered. The worker and employer contribution series come from Figures 6.3, 6.4 and 6.5 in the Section 6 tables. KFF runs the survey itself, so these are first-hand figures rather than a summary of someone else's.
- CMS, Health Insurance Exchanges 2026 Open Enrollment Report: the 23.1 million plan selections, the $619 and $178 average monthly premiums, the 87% with a credit, the $0 and $50 distributions, the $15 and $36 changes for credit-receiving consumers, the metal-level shift and the HSA-eligible enrolment. The 2025 edition supplied the prior-year comparison.
- BLS Consumer Expenditure Survey, calendar-year tables, Table 1203 for 2024: the $4,055 health insurance figure, the healthcare breakdown and the shares of total spending. The definition of an expenditure comes from the CE Handbook of Methods, and the scope of the health insurance item from the CE glossary.
- BLS, Employer Costs for Employee Compensation, June 2026, released 9 September 2026: the $3.48 per hour and 7.4% of compensation for private industry, and the $7.61 and 11.4% for state and local government.
- IRS Revenue Procedure 2025-25 and Revenue Procedure 2026-26: the applicable percentage tables for 2026 and 2027 under Internal Revenue Code section 36B.
- Inflation Reduction Act of 2022, Public Law 117-169, section 12001: the statutory text that set the enhanced credits to lapse "before January 1, 2026". The HHS Notice of Benefit and Payment Parameters for 2027, 91 FR 29526, published 20 May 2026, is the quoted confirmation that they expired.
- 45 CFR 147.102, Fair health insurance premiums and 45 CFR 147.108, Prohibition of preexisting condition exclusions, both read at the eCFR issue date of 25 September 2026, with their statutory parents at sections 2701 and 2704 of the Public Health Service Act as added by the Affordable Care Act.
- HHS, Marketplace Integrity and Affordability final rule, 90 FR 27074: the $10,600 maximum annual limitation on cost sharing finalised for the 2026 plan year. The 2025 HHS poverty guidelines supplied the $15,650 and $32,150 used for the 400% calculation, and 45 CFR 155.300(a) is the rule that makes the 2025 guidelines the ones that govern 2026 coverage.
What we deliberately did not state. No 2026 figure for employer-sponsored premiums, because the KFF survey for 2026 has not been published; the 2025 edition appeared in October 2025 and the 2024 edition in October 2024, so a 2026 edition is expected shortly. No 2025 or 2026 household spending figure, because BLS Consumer Expenditure data stops at 2024. No premium taken from an insurance quote site or comparison tool: those publish sample quotes for a hypothetical person, not filed or surveyed premiums. No state-level marketplace premiums, because we did not parse the CMS state public use file. No average benchmark premium change for 2026, because we could not locate a current CMS choice-and-premiums report. No list of which states restrict tobacco rating, because we did not verify it statute by statute. No forecast of what Congress may do about the enhanced premium tax credits.
This article is for general information and is not insurance, tax or financial advice. All figures were checked against the primary sources listed above on 30 September 2026. The employer-coverage data year is 2025, the marketplace data is for the 2026 plan year, and the household spending data is for 2024. Monthly figures marked as equivalents are annual figures divided by twelve. Premiums and subsidies are individual to your age, household, income and location, and your own cost will differ from any average. Check your own plan documents and speak to a licensed agent, a certified marketplace assister or a tax professional before acting.
FAQ
What is the average cost of health insurance?
It depends which coverage you mean. Job-based coverage averaged $9,325 a year for one person and $26,993 for a family in 2025, per KFF. Marketplace plans averaged $619 a month before subsidy and $178 after for the 2026 plan year, per CMS. Households paid $4,055 out of their own pockets in 2024, per BLS.
How much does health insurance cost per month through work?
The worker's share averaged $120 a month for single coverage and $571 for family coverage in 2025. The full plan cost about $777 and $2,249 a month respectively, with the employer covering the difference.
How much of my premium does my employer pay?
On average 84% of a single premium and 74% of a family premium in 2025, which is $7,884 and $20,143 a year. At firms with 10 to 199 workers, 29% of covered workers are in a plan where the employer pays the entire single premium.
Did the enhanced ACA subsidies expire?
Yes. The Inflation Reduction Act extended them only through plan year 2025, and HHS confirmed in May 2026 rulemaking that they "expired at the end of 2025". The IRS applicable percentage tables for 2026 and 2027 use the original schedule and contain no band above 400% of the federal poverty line.
Can I still get a subsidy above 400% of the poverty line?
Not for 2026 or 2027 under current law. Using the 2025 poverty guidelines that govern 2026 coverage, 400% is $62,600 for one person and $128,600 for a household of four in the 48 contiguous states and Washington DC.
What actually makes my ACA premium higher than someone else's?
Only four things may legally change the rate in the individual and small group markets: whether the plan covers an individual or a family, your rating area, your age (capped at a 3:1 spread for adults) and tobacco use (capped at 1.5:1). Everything else, including your medical history, is off limits under 45 CFR 147.102.
Can an insurer charge me more or refuse me for a pre-existing condition?
No. 45 CFR 147.108 states that a group health plan or an issuer offering group or individual coverage "may not impose any preexisting condition exclusion", and the regulation's own example treats refusing an applicant because a physical found type 2 diabetes as a prohibited exclusion.
Why is the average marketplace premium after subsidy so much lower than the sticker price?
Because 87% of enrollees received an advance premium tax credit for 2026. On the HealthCare.gov platform, 29% of consumers paid $0 a month after the credit and 54% paid $50 or less.
What is the most a health plan can cost me in a year beyond premiums?
For plans subject to the federal limit, the maximum annual in-network cost sharing for the 2026 plan year is $10,600 for self-only coverage and $21,200 for other than self-only coverage. Your own plan may set a lower limit; in 2025, 12% of covered workers had a single-coverage limit of $2,000 or less.
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"Average Health Insurance Cost: Three Honest Numbers." Wealthy Pot, 2026. https://wealthypot.com/average-health-insurance-cost/
