One bad week can cost more than a year of coverage.

The clock is already running

Lost your coverage? You usually have 60 days to pick a Marketplace plan through a Special Enrollment Period. HealthCare.gov: Special Enrollment Periods

Miss it, and you may have to wait for Open Enrollment: November 1 to January 15, and December 15 for coverage that starts January 1. HealthCare.gov: dates and deadlines

Until you’re covered, an ER visit, an ambulance ride or a scan is billed at the full price, with no cap. Four in ten adults already carry debt from medical or dental bills. KFF Health Care Debt Survey

Real people. Real bills.

These are reported cases, not made-up examples. Each one links to the full story.

Cheap short-term plan

$7,226.71

Tim Winard, 57 Addison, Illinois

He left his job to start a business and bought a short-term plan for about $500 a month because a Marketplace plan looked too expensive. A routine colonoscopy came to $10,723.19. His plan paid only up to $1,000 a day for outpatient surgery, so it paid $817.47 and left him owing $7,226.71.

After he hired an advocate and reporters asked questions, the insurer cut his bill to $770.

Short-term plans don’t have to follow ACA rules. They can cap what they pay and skip preventive care.

Read the full story → Julie Appleby, KFF Health News, March 28, 2025

No insurance

$9,250

Elisabeth Yoder and her son Darragh, 15 months Mechanicsburg, Ohio

The family had no health insurance: their income was a little too high for Medicaid or Ohio’s children’s program, and they relied on a Christian health care sharing ministry. When Darragh got a serious skin infection, a 39-mile ambulance transfer to a children’s hospital, with no siren, was billed at $9,250.

They negotiated the ambulance bill down to $5,600 and set up payment plans for about $6,800 in hospital bills.

Without insurance there are no negotiated rates and no out-of-pocket cap. You get the full bill.

Read the full story → Tony Leys, KFF Health News, November 25, 2025

High deductible

$5,169.67

Dani Yuengling Conway, South Carolina

She had insurance through work, with a high deductible. The hospital charged $17,979 for a needle biopsy of a lump in her breast. Because she hadn’t met her deductible, she was billed $5,169.67 of it. The hospital’s own website had listed the procedure at about $1,400 for people paying without insurance.

After disputing the bill she paid $3,306.29.

A high deductible means you pay the first thousands yourself. Know your number before you need care.

Read the full story → Lauren Sausser, KFF Health News, August 23, 2022

No insurance

$23,000

Ronmel Rangel, 63 Portland, Maine

He went without insurance because Marketplace premiums were beyond his budget. When he needed hernia surgery, his local hospital estimated about $23,000.

He spent months shopping, looked as far as Chile, and finally flew to Maryland for a $2,900 surgery plus about $1,800 in travel.

Uninsured, you become your own price shopper for surgery, and the first quote can be five figures.

Read the full story → Paula Andalo, KFF Health News, July 29, 2026

The five words on every plan

Premium

What you pay every month to keep the plan, whether you use it or not.

Deductible

What you pay for covered care each year before the plan starts sharing the cost.

Copay

A flat fee for a visit or prescription, like $30 to see your doctor.

Coinsurance

Your share after the deductible, like 20% of a $5,000 bill = $1,000.

Out-of-pocket maximum

The most you pay in a year for covered, in-network care. After that the plan pays 100%. For 2026 Marketplace plans the limit is $10,600 for one person and $21,200 for a family. HealthCare.gov: out-of-pocket maximum

The real cost of a plan = 12 months of premiums + what you’re likely to pay out of pocket. The cheapest monthly price is often not the cheapest year.

Marketplace plans (the ACA)

Pre-existing conditions are covered. You can’t be turned down or charged more for your health.
Ten essential benefits, including emergencies, hospital stays, maternity, mental health and prescriptions.
Preventive care at no cost in network, like checkups and screenings.
A yearly out-of-pocket cap ($10,600 for one person in 2026).
Tax credits can lower the premium depending on income and household. The extra credits from recent years expired on December 31, 2025, so many people pay more in 2026 and credits stop above 400% of the poverty level. KFF: 2026 Marketplace premiums and deductibles

BronzePlan pays about 60%

SilverAbout 70%

GoldAbout 80%

PlatinumAbout 90%

Metal levels are about how costs are split, not the quality of care. HealthCare.gov: the metal categories

Private plans, and plans that aren’t what they seem

Private ACA plans. Many companies also sell ACA-compliant plans directly. Same protections as the Marketplace, but no tax credit.
Short-term plans. Lower premiums, but they don’t have to follow ACA rules. They can leave out pre-existing conditions, cap what they pay, and skip preventive care.
Fixed indemnity plans. Pay a set dollar amount per day or visit, no matter what the bill is. Useful as an add-on, risky as your only coverage.
Health care sharing ministries and discount plans. Not insurance. They are not required to pay your bills, and they don’t have insurance protections. NAIC: not all products are health insurance

Before you buy any lower-cost plan, ask: what’s the most it pays, what does it leave out, and what happens if I’m in the hospital for a week? A licensed agent reads the fine print with you.

High or low deductible?

High deductible

Lower monthly premium. You pay more of the first bills yourself. Fits people who rarely see a doctor and could cover the deductible if something happened.

Low deductible

Higher monthly premium. The plan starts sharing costs sooner. Fits people expecting care: a baby, a surgery, regular specialist visits.

Deductibles are climbing. The average Marketplace deductible rose 37% to $3,786 in 2026. KFF: 2026 Marketplace premiums and deductibles

HMO, PPO, EPO: who you can see

HMO. Usually lower cost. You pick a primary doctor and need referrals; out-of-network care generally isn’t covered except emergencies.
PPO. More freedom. See specialists without referrals and get some coverage out of network, for a higher premium.
EPO. No referrals, but you stay in network except emergencies.

Read the full guide: HMO, PPO, EPO → How to check your doctor is in network →

Prescriptions

Every plan has a formulary, its list of covered drugs, sorted into price tiers.
The same medicine can be cheap on one plan and expensive on another. Check every one you take.
Some drugs need prior approval or trying a cheaper one first.

Read the guide: will my prescriptions be covered? →

When you can enroll

Open Enrollment: November 1 to January 15. Enroll by December 15 for coverage starting January 1. HealthCare.gov: dates and deadlines
Special Enrollment: losing job coverage, moving, marriage, a new baby and other life events open a window, usually 60 days. HealthCare.gov: Special Enrollment Periods
Losing work coverage? COBRA lets you keep it, usually at full price. A Marketplace or private plan may cost less.

Read the guide: lost your coverage? → COBRA or a new plan? →

Don’t wait for a bill to find out what you’re missing.Answer a few questions and a licensed agent calls you.Qualify Today

General information, not advice for your situation. Plan details, prices and rules vary by state, ZIP code and eligibility. Stories are summarized from the reporting linked on each card.