US Health Insurance Costs: Premiums, Deductibles, Out-of-Pocket

For many Americans the premium is only the entry fee. Before insurance pays much of anything, there is a deductible, then coinsurance, up to an annual out-of-pocket maximum, and the premiums keep running all year. This guide sets out what US health insurance costs per month, what a year can add up to in the worst case, what is free before the deductible, what Medicare costs, and when paying cash at home or abroad is worth comparing.

How much does health insurance cost per month in the US?

Through an employer, the average total premium in 2025 was USD 9,325 a year for single coverage, about USD 777 a month, of which workers paid USD 1,440 on average and employers the rest, according to the KFF Employer Health Benefits Survey. Buying your own plan, as many self-employed people and early retirees do, the average benchmark silver marketplace plan for a 40-year-old costs USD 625 a month before subsidies in 2026, according to KFF. Premiums rise with age and vary a lot by state, and income-based tax credits can lower what you pay.

If you are self-employed, you may be able to deduct the premiums you pay for yourself, your spouse and dependants under the IRS self-employed health insurance deduction. Check the IRS instructions or a tax adviser for whether you qualify.

How much does health insurance cost per year for a family, including the deductible?

The average employer family premium was USD 26,993 in 2025, of which the worker paid USD 6,850 on average (KFF). On top of the premium sit the deductible and coinsurance. The worst-case year is set by the out-of-pocket maximum: for 2026, marketplace plans can make you pay up to USD 10,600 for an individual and USD 21,200 for a family for covered in-network care (HealthCare.gov). HSA-eligible high-deductible plans must have a deductible of at least USD 1,700 (self-only) or USD 3,400 (family), with out-of-pocket maximums of USD 8,500 and USD 17,000 (IRS, 2026).

The premium never counts towards the out-of-pocket maximum. So a family with a high-cost year on a marketplace plan pays its premiums plus up to USD 21,200, and out-of-network care and excluded services can come on top.

Does insurance pay anything before the deductible is met?

Yes for some things. Marketplace and many other plans must cover listed preventive services, such as recommended screenings, with no copay or coinsurance even before the deductible, when you use an in-network provider (HealthCare.gov). Many plans also charge a flat copay for office visits or prescriptions before the deductible. For most tests, scans and surgery, though, you pay the insurer's negotiated rate in full until the deductible is met, then your coinsurance share.

The negotiated rate still helps before the deductible. Your explanation of benefits shows the allowed amount, which is usually far below the hospital's list charge, and what you pay counts towards your deductible.

How much does surgery cost with insurance compared with paying cash?

With insurance, surgery costs you whatever is left of your deductible plus your coinsurance, up to the out-of-pocket maximum. For a single planned operation early in the year on a high-deductible plan, that can mean several thousand dollars even when everything is covered.

Paying cash can be cheaper when you have not met your deductible and the facility offers a low bundled price, but cash payments may not count towards your deductible, so ask before you choose. Our guides on what a procedure really costs and when self-pay is cheaper walk through how to compare.

The same logic applies abroad. Patients in China report a median total hospital bill of CNY 30,000 (≈ USD 4,500) for a knee replacement and CNY 23,250 (≈ USD 3,450) for endoscopic or minimally invasive disc surgery, before insurance (Chinese patient reports, 2025–26). These are standard-department prices at public hospitals; foreign patients pay the full price, and international departments charge more. If your out-of-pocket share at home is already several thousand dollars, a written, itemised price from a large hospital in China, with flights and recovery time added, is another option worth pricing.

How much does Medicare cost, and how much of a procedure does it cover?

In 2026 the standard Part B premium is USD 202.90 a month and the Part B deductible is USD 283 a year. If you are admitted to hospital, the Part A inpatient deductible is USD 1,736 (CMS). After the Part B deductible, you usually pay 20% of the Medicare-approved amount for doctor services and outpatient care, with no annual cap in Original Medicare (medicare.gov).

That open-ended 20% is why many people add a Medigap supplement or choose a Medicare Advantage plan. Premiums and benefits for both vary by plan, age and state, so compare them on medicare.gov. For treatment abroad, Medicare usually doesn't cover health care while you are travelling outside the US, and some Medigap policies may cover emergency care abroad only, not planned surgery (as of October 2026).

Why do insurance companies deny claims when you pay premiums?

Paying premiums keeps your policy active, but each claim is still checked against the plan's rules. Insurers on HealthCare.gov denied 19% of in-network claims in 2023, with reasons including missing prior authorization or referral, medical necessity and excluded services, and fewer than 1% of denials were appealed, according to KFF.

Before you accept a denial, ask for the reason in writing, check whether it was a billing or coding error, and file an internal appeal with your doctor's support. If that fails, you can usually ask for an external review. Our guide on how to appeal a health insurance denial explains each step. Plan rules differ, so confirm the deadlines with your insurer.