Best Individual Health Insurance in the USA (2025)

Choosing individual health insurance in the U.S. feels like trying to read a foreign language while someone’s rushing you. There’s no universal “best” plan—what works for your coworker might be completely wrong for you. Your income matters. Where you live matters. How often you actually go to the doctor matters a lot.

And 2025? It’s a particularly weird year for individual health insurance. Rules are changing, some big insurers are backing out of markets, and premiums are doing that thing where they go up even when officials say they’re going down. Fun times.

We’ll look at what actually matters when you’re comparing plans, which insurance companies are worth considering, and how to figure out what you need based on your real life—not some theoretical perfect scenario.

What Actually Matters When You’re Choosing a Plan

Before we get into specific insurance companies and their plans, let’s talk about what you should actually be evaluating for individual health insurance. Because honestly, most people focus on the wrong things.

Monthly Premiums vs. What You’ll Actually Spend

Everyone looks at the monthly premium first. Makes sense—it’s the number that hits your bank account every month, whether you use healthcare or not. But here’s what trips people up: a plan with a $200 monthly premium and a $6,000 deductible might cost you way more over a year than a plan with a $400 premium and a $2,000 deductible.

Do the math based on your real expected usage when choosing individual health insurance. If you see a therapist weekly, take daily medications, or have a chronic condition that requires regular specialist visits, those cheaper premiums will cost you more in the long run. You’ll be paying that deductible out of pocket before your insurance really kicks in.

On the flip side, if you’re 28, healthy, and basically just need coverage in case you get hit by a bus? That low-premium, high-deductible plan might be perfect. You’re betting on not needing much care. Sometimes that bet pays off.

Deductibles and Out-of-Pocket Maximums

Your deductible is what you pay before your insurance starts covering most things. Some preventive care is covered before you hit the deductible, but for most services—doctor visits, imaging, surgeries—you’re paying full price until you meet it.

The out-of-pocket maximum is your safety net. It’s the absolute most you’ll pay in a year for covered services. For 2025, the government caps this at $9,200 for individual ACA marketplace plans. Once you hit that number, your insurance covers 100% of covered services for the rest of the year.

Here’s a real scenario: Sarah picked a Bronze plan with a $7,500 deductible because the premium was only $150/month. Then she needed emergency surgery in March. She paid $7,500 out of pocket before insurance kicked in, plus coinsurance that brought her close to the out-of-pocket max. Total annual cost: $9,000 in medical bills plus $1,800 in premiums = $10,800. If she’d chosen a Silver plan with a $3,000 deductible and $300/month premium, she would’ve paid $3,000 deductible plus coinsurance and premiums totaling around $7,500 for the year. The “cheaper” plan cost her $3,300 more.

You can’t predict emergencies. But you can look at your out-of-pocket maximum and ask yourself: “If I had to pay this amount next year, would it destroy me financially?” If yes, consider a plan with better cost-sharing.

Network Types: HMO, PPO, EPO

This is where people get confused, and it matters more than you’d think.

HMOs (Health Maintenance Organizations) are the most restrictive but usually the cheapest. You pick a primary care doctor who becomes your gatekeeper. Want to see a cardiologist? You need a referral. Go to a doctor outside the network? You’re paying full price—your insurance won’t cover it at all except in emergencies.

HMOs work great if you’re okay with the structure and all your preferred doctors are in network. They don’t work if you like to self-refer to specialists or if you travel a lot. I’ve seen people stuck in HMOs try to get specialist care and wait weeks for a referral appointment with their PCP before they can even book with the specialist they actually need.

PPOs (Preferred Provider Organizations) give you flexibility. You can see any doctor you want, in or out of network, with no referrals needed. In-network care costs less, out-of-network care costs more, but at least it’s partially covered. This flexibility costs you—PPO premiums run 15-30% higher than comparable HMO plans.

PPOs make sense if you have established relationships with doctors who might not all be in the same network, if you split time between different states, or if you just value the freedom to seek care without jumping through hoops.

EPOs (Exclusive Provider Organizations) are the middle ground. You don’t need referrals, but you must stay in network (except emergencies). They’re less common but worth considering if you find one—they can offer PPO-like freedom at closer to HMO prices.

Metal Tiers: Bronze, Silver, Gold, Platinum

ACA marketplace plans use metal tiers to indicate how costs are split between you and the insurer:

Bronze: Insurance pays about 60% of costs, you pay 40%. Lowest premiums, highest cost-sharing.
Silver: 70/30 split. The “balanced” option and important if you qualify for cost-sharing reductions.
Gold: 80/20 split. Higher premiums, lower costs when you use care.
Platinum: 90/10 split. Highest premiums, minimal cost-sharing.

But here’s what the percentages don’t tell you: they’re averages across a population. Your personal split depends entirely on how much care you use.

Let’s say you’re comparing Bronze vs. Gold. Bronze premium: $250/month ($3,000/year). Gold premium: $450/month ($5,400/year). The Gold plan costs you $2,400 more in premiums just for having it.

If you never go to the doctor? You wasted $2,400. If you have $8,000 in medical expenses? The Gold plan’s lower deductible and coinsurance might save you $3,000+ in out-of-pocket costs, making it cheaper overall despite the higher premium.

The metal tier that’s “best” for you depends on your expected usage. And be honest with yourself about this—don’t assume you’ll be healthier than you actually are just to justify the cheaper premium.

Subsidies and Tax Credits

If you’re buying through the ACA marketplace and your income is between roughly 100% and 400% of the federal poverty level, you probably qualify for premium tax credits. For 2025, that’s approximately $15,000 to $60,000 for an individual (the ranges adjust annually and vary by household size).

These credits can be huge. Someone making $35,000 might see their $400/month premium drop to $150/month after subsidies. That’s $3,000 in savings per year.

You can take the credit in advance (applied monthly to reduce your premium) or claim it when you file taxes. Most people take it monthly because waiting a year for $3,000 isn’t realistic when you’re trying to afford coverage now.

Cost-sharing reductions are different—they only apply to Silver plans and only if your income is below 250% of the poverty level (roughly $37,000 for an individual in 2025). These reductions lower your deductible, copays, and out-of-pocket maximum. A Silver plan with CSR can have cost-sharing as good as a Gold or Platinum plan while keeping Silver-level premiums.

If you qualify for CSR, Silver plans become incredibly valuable. Don’t automatically go Bronze just because the premium is lower.

Provider Networks Matter More Than You Think

Your insurance is only as good as the doctors who accept it. Before you enroll in any plan, actually verify that your current doctors are in network. Don’t just assume. Don’t rely on what the insurance rep tells you on the phone. Go to the insurer’s website, use their provider search tool, and confirm.

Then—and this is the step people skip—call your doctor’s office and ask: “Do you accept [Insurance Company Name] [Plan Name]?” Sometimes the provider directory is outdated. Sometimes your doctor accepts UnitedHealthcare PPO but not UnitedHealthcare HMO. Get confirmation.

If you don’t have established doctors, look at the network size. Some plans have robust networks with hundreds of providers nearby. Others are super limited—especially EPO and HMO plans in rural areas. You don’t want to discover mid-year that the only in-network cardiologist is 90 miles away.

Additional Features That Might Actually Matter

Telehealth has become standard, but implementation varies wildly. Some plans include unlimited virtual primary care visits for $0. Others charge you $40 per visit. If you’re someone who’d use virtual care for minor stuff—UTIs, rashes, routine med refills—this adds up.

Prescription drug coverage is buried in plan documents, but it’s critical if you take regular medications. Check the plan’s formulary (the list of covered drugs) and see what tier your medications fall into. Tier 1 drugs might cost you $10. Tier 4 specialty drugs could be $300+ per month even with insurance.

Some insurers offer mail-order pharmacy services where you can get 90-day supplies at a lower cost than 30-day retail. If you take maintenance medications, this can save hundreds per year.

Top Individual Health Insurance Providers in 2025

Not all insurance companies are created equal. Some have better networks, some have better customer service, and some are stronger in certain states. Here’s who’s worth looking at:

Kaiser Permanente

Kaiser operates differently than most insurers—they’re both the insurance company and the healthcare provider. You go to Kaiser hospitals, see Kaiser doctors, and use Kaiser pharmacies. It’s a closed system.

The upside: coordination is seamless. Your primary care doctor can instantly see what your specialist recommended. Getting referrals is faster. Preventive care is usually excellent. Patient satisfaction scores are consistently high.

The downside: you’re locked into Kaiser facilities and providers. If Kaiser doesn’t operate in your area, it’s not an option. If you move to a state without Kaiser, you need new insurance. Some people feel the closed system is too restrictive.

Kaiser works really well if you’re in California, Colorado, Hawaii, Oregon, Washington, or a few other states where they have a strong presence. It works less well if you value choosing your own doctors or if you split time between states.

UnitedHealthcare

UnitedHealthcare is massive—probably the largest health insurer by membership. They have networks everywhere, strong digital tools, decent telehealth options, and a wide range of plan types.

The advantage of UHC is flexibility and reach. Their PPO plans let you see practically any doctor in the country. AlsoTheir network size means you’re less likely to face access issues. Their app is reasonably good for checking claims and finding providers.

The tradeoff: premiums can be high, especially for PPO plans. Customer service is hit or miss—you might get someone helpful or you might get bounced around phone menus for 40 minutes. Out-of-network costs are steep if you go that route.

UHC makes sense if you want a big, established insurer with lots of options, or if you need broad national access because you travel frequently.

Blue Cross Blue Shield

BCBS isn’t one company—it’s an association of 34 independent companies operating under the same brand. This means your experience with BCBS in Texas might be completely different from BCBS in New York.

Generally, BCBS plans have large networks, decent provider access, and a trusted brand name. They offer everything from Bronze HMOs to Gold PPOs. Prices vary significantly by state.

The fragmentation is both good and bad. Good because local BCBS companies understand their markets. Bad because there’s no unified digital experience, and if you move states, you’re essentially dealing with a different company.

BCBS is a solid, safe choice in most states. They’re particularly strong in areas where other national insurers have limited presence.

Cigna

Cigna has good HSA-compatible high-deductible plans, strong virtual care options, and decent global coverage if you travel internationally. They’re particularly appealing to healthy people who want to maximize HSA contributions for tax benefits.

The catch with Cigna’s HSA plans: you’re accepting high deductibles (typically $3,000-$7,000 for individuals) in exchange for lower premiums and HSA eligibility. This works great until you actually need significant care.

Cigna’s network varies by location. In some markets, they’re robust; in others, they’re limited. Check carefully before committing.

Oscar Health

Oscar is newer, tech-focused, and designed around their app. Virtual care is built in, often with $0 copays. The interface is cleaner than legacy insurers. Customer service is generally more responsive.

Oscar is great if you’re comfortable managing healthcare digitally and don’t need extensive in-person specialist care. They’re less ideal if you have complex medical needs requiring lots of coordination with multiple specialists.

Oscar isn’t available in all states, and their networks can be smaller than established insurers. But for young, relatively healthy people who value user experience, they’re worth considering.

Aetna

Aetna has historically been solid, with good pharmacy integration (they’re owned by CVS Health). But here’s the problem: Aetna announced it’s exiting the ACA exchanges in 2026. They’re pulling out of the individual market.

If you’re shopping for 2025 coverage, Aetna might still be available in your state. But you’ll need to find a new insurer for 2026, which means going through this whole process again next year. For that reason alone, I’d probably look elsewhere unless Aetna is significantly cheaper and you’re okay with the hassle of switching.

How to Actually Choose Your Plan

Here’s a realistic process for narrowing down your options for individual health insurance:

Start With Your State’s Marketplace

Go to your state’s ACA exchange or HealthCare.gov if your state uses the federal marketplace. Enter your ZIP code, household size, and estimated income for 2025.

The marketplace will show you plans available in your area with estimated premiums after subsidies (if you qualify). This is your shortlist.

Estimate Your Real Healthcare Usage

Think about last year. How many doctor visits? Specialist appointments? Prescription refills? Any planned procedures for next year? Be realistic—not pessimistic, but not overly optimistic either.

If you saw your doctor 8 times, used three prescriptions monthly, and had one ER visit, you’re a moderate user. Calculate what that would cost under different plans:

Bronze plan: You’d hit maybe $4,000 of your $6,000 deductible, plus premiums
Silver plan: You’d hit your $3,500 deductible, plus premiums
Gold plan: Lower deductible means more is covered, lower total out-of-pocket

Run the numbers. There are calculators online that can help, or you can do it manually with the plan documents.

Check Your Doctors

Pull up the provider search tool for each plan you’re considering. Enter your current doctors—primary care, specialists, therapists, anyone you see regularly. Make sure they’re in network.

Then call their offices to confirm. Seriously. “Hi, I’m looking at switching to [Plan Name] from [Insurance Company]. Do you accept this plan?” Get a yes or no. If no, scratch that plan or be prepared to find new doctors.

Compare Two or Three Finalists Side by Side

Don’t try to compare eight plans. You’ll get overwhelmed and make a worse decision. Narrow it to two or three, then compare:

Monthly premium
Annual deductible
Out-of-pocket maximum
Do your doctors accept it?
What’s your copay for primary care, specialists, and ER?
Are your prescriptions covered, and what tier?
Is it an HMO, PPO, or EPO?

Make a simple spreadsheet if that helps you visualize the tradeoffs.

Consider Using a Broker

Licensed health insurance brokers can walk you through options at no cost to you—they’re paid by insurers. A good broker knows which plans have better networks in your area, which insurers pay claims faster, and which ones have frustrating prior authorization processes.

Brokers are especially helpful if you have complex needs (multiple chronic conditions, large families, self-employment income that’s hard to predict). They’re less necessary if you’re young, healthy, and the decision is straightforward.

Enroll During Open Enrollment

For ACA marketplace plans, open enrollment typically runs from November 1 through January 15 (dates can vary slightly by state). You need to enroll during this window unless you qualify for a Special Enrollment Period.

SEPs happen when you have qualifying life events: losing other coverage, getting married, moving to a new state, or having a baby. If you miss open enrollment and don’t have an SEP, you’re stuck without coverage (or paying full price for non-ACA plans) until the next open enrollment.

Common Mistakes People Make

Choosing Based Solely on Premium

The lowest premium plan is seldom the cheapest plan once you factor in what you’ll actually spend on healthcare. If you use any care at all, that Bronze plan with the $100/month premium and $7,000 deductible will cost more than the Silver plan with the $250/month premium and $3,000 deductible.

Not Verifying Provider Networks

“My doctor accepts UnitedHealthcare” is not the same as “My doctor accepts this specific UnitedHealthcare plan.” Networks vary by plan type even within the same insurer. Verify. Every. Time.

Ignoring Cost-Sharing Reductions

If your income qualifies you for CSR (below about $37,000 for individuals), you should almost certainly pick a Silver plan. The cost-sharing reductions make Silver plans perform like Gold plans while keeping Silver premiums. People skip this because they don’t understand how valuable CSR is.

Forgetting to Update Income Estimates

Your subsidy is based on your estimated income when you enroll. If you estimate $40,000 but actually earn $55,000, you’ll owe some of the premium tax credit when you file taxes. If you estimate $55,000 but only earn $40,000, you left money on the table all year.

Report income changes to the marketplace when they happen so your subsidy adjusts. You can update your estimate anytime.

Not Reading the Evidence of Coverage

The summary of benefits is helpful, but the full Evidence of Coverage document tells you what’s actually covered and what’s not. Buried in there: which surgeries require prior authorization, whether your plan covers out-of-state care, what happens if you need air ambulance service (spoiler: it’s expensive).

You don’t need to read 100 pages, but skim through sections relevant to your needs.

What’s Happening With Insurance in 2025-2026

The market is shifting in ways that might affect your decision with individual health insurance:

Premiums Are Weird Right Now

CMS finalized a rule in mid-2025 aimed at lowering marketplace premiums by an average of 5%. Some people will see decreases. Others will see increases because insurers are still adjusting rates based on claims experience and medical inflation.

The “average” doesn’t mean your premium drops 5%. It might drop 10%. Also, it might increase 8%. It depends on your state, your insurer, and your specific plan.

Enhanced Subsidies Might Not Last

The enhanced premium tax credits that have made ACA plans more affordable for millions of people are at risk politically. These subsidies expanded who qualifies and how much help they get. If they expire or get reduced, premiums will effectively increase for anyone who was receiving them.

This isn’t fearmongering—it’s a real possibility depending on legislation. If you’re counting on substantial subsidies, have a backup plan for what you’d do if they’re reduced.

Some Insurers Are Leaving

Aetna is exiting the ACA exchanges in 2026. If other insurers follow, plan options could shrink in some markets. Less competition typically means higher prices and fewer choices.

Watch what happens in your state. If your current insurer announces they’re pulling out, you’ll need to shop during the next open enrollment.

Income Verification Is Getting Stricter

The 2025 Marketplace Integrity and Affordability Final Rule tightens income verification to reduce improper enrollments. This mostly affects edge cases where people were gaming the system, but it might also mean more paperwork for legitimate enrollees to prove their income.

If you’re self-employed or have a variable income, keep good documentation. You might need to provide tax returns, profit and loss statements, or other proof.

Plans by Scenario

You’re 26, Healthy, and Rarely Go to the Doctor

Look at Bronze plans from BCBS, Oscar, or Kaiser if available. Your goal is to minimize the premium since you’re unlikely to hit the deductible. Make sure the plan covers preventive care at 100% (they all should), and check the out-of-pocket maximum in case something catastrophic happens.

Consider an HSA-eligible high-deductible plan from Cigna. If you can afford to contribute to the HSA, you get a tax deduction and build a medical expense fund.

You’re freelancing, Income Around $45,000

You probably qualify for some premium tax credits. Focus on Silver plans—they offer the best balance of premium and coverage, and if your income is lower than you estimated, you might qualify for cost-sharing reductions.

Compare Silver plans from UHC, BCBS, and local insurers. Check networks carefully since you don’t have an employer relationship to fall back on if things go wrong.

You’re 55, Taking Blood Pressure Meds, and see a Doctor Quarterly

You’re using healthcare regularly, so low cost-sharing matters more than low premiums. Look at Gold plans or lower-deductible Silver plans.

Make sure your current doctors accept the plan—at 55, you probably have established relationships you don’t want to give up. Kaiser Gold or BCBS Gold would be good starting points if they have your providers.

Run the math: your quarterly visits plus prescriptions will hit a lower deductible faster, meaning the plan starts covering more earlier in the year.

You Have Kids Who See Pediatricians and Specialists

Your usage is high and unpredictable. Kids get ear infections, break bones, and need therapists or specialists. You need a plan with a reasonable out-of-pocket maximum and good pediatric networks.

Silver plans with CSR (if you qualify) or Gold plans make sense. PPOs might be worth the extra premium for flexibility to see different specialists without referral hassles.

BCBS typically has good pediatric networks. Kaiser is excellent for families if you’re comfortable with their system. Check whether your kids’ current pediatrician accepts the plan.

You Travel Frequently for Work

You need coverage that works across state lines. PPO plans from UHC or BCBS give you that flexibility. HMOs will leave you stuck if you need care while traveling (except emergencies).

The premium will be higher, but it’s worth it to avoid situations where you’re sick in another state and can’t find an in-network urgent care.

Individual Health Insurance: Red Flags to Watch For

Unusually Low Premiums

If one plan is $100/month cheaper than similar plans, there’s a reason. Usually, it’s a terrible network with almost no participating providers, or it’s a short-term plan that doesn’t comply with ACA rules and can deny coverage for pre-existing conditions.

If it seems too good to be true, it probably is.

Vague Provider Directories

You search for doctors, and the directory says “results temporarily unavailable” or returns obviously outdated information? Red flag. This insurer doesn’t maintain its network data, which means you’ll have a nightmare trying to figure out who’s actually in network.

Plans That Require Lots of Prior Authorization

Some insurers require prior authorization for everything—imaging, physical therapy, and specialist visits. This creates delays and hassles. You can sometimes find this information in online reviews or by asking your broker.

Sky-High Out-of-Pocket Maximums

If a plan’s out-of-pocket max is near the $9,200 limit and you’d struggle to pay that, it’s not protecting you enough. Look for plans with lower OOP maxes, even if premiums are higher.

After You Enroll in Individual Health Insurance: What Happens Next

You’ll get an insurance card in the mail (or digital card via app) usually within 2-3 weeks. Your coverage starts January 1 if you enrolled during open enrollment.

Set up your online account with the insurer immediately. Download their app. Verify that your doctors show as in-network in their system.

If you’re getting subsidies, the marketplace sends payment directly to your insurer each month. You just pay the difference. Keep documentation of these payments for tax filing.

File your taxes carefully. You’ll get Form 1095-A showing your enrollment and subsidies. You need this to reconcile your premium tax credit. If you got too much subsidy, you pay it back (up to certain limits). If you got too little, you get a refund.

Conclusion

There’s no universal best individual health insurance plan. Kaiser Permanente, UnitedHealthcare, Blue Cross Blue Shield, Cigna, and Oscar Health are all solid options depending on your situation. What matters is matching the plan to your real needs—not some idealized version of your healthcare usage.

Balance premiums against out-of-pocket risk. Verify your doctors are in network before enrolling. Understand what subsidies you qualify for. And plan to reevaluate every year during open enrollment, because 2025 and 2026 are shaping up to be particularly dynamic years for individual health insurance.

If you’re unsure about the right individual health insurance, talk to a broker. Spend an hour running the numbers. Don’t just pick the cheapest premium and hope for the best. Your future self will thank you for choosing the right individual health insurance.