A guide to buying individual health insurance in the United States in 2025: plans and costs, government subsidies, insurance companies and purchasing channels

Coinsurance : Usually you choose a percentage, and you will encounter it only after the deductible amount is full. For example, if you choose 30% coinsurance, the medical expenses are $100, the insured only needs to pay $30, and the insurance company will cover the remaining $70.

It should be noted that the coinsurance charged for in-network and out-of-network medical services is different, and the coinsurance for out-of-network medical services is usually higher.

Out-of-pocket maximum/limit : When the total amount of money you pay exceeds this limit, the insurance company will pay it in full. This is a cumulative system. For example, if the Out-of-pocket Max is $10,000, and this year’s deductible, coinsurance and other medical bills add up to $25,000, you only need to pay $10,000, and the remaining $15,000 will be paid by the insurance company.

Types of Medical Insurance Plans

HMO (Health Maintenance Organization) : One of the most common health insurance plans. You must choose a Primary Care Physician (family doctor). If you want to see a specialist, you must first get a referral from your family doctor (emergency and obstetrics and gynecology can be seen directly without a referral). These specialists must be doctors in the network. The premiums are usually cheaper.

PPO (Preferred Provider Organization) : One of the most common health insurance plans. You don’t have to choose a family doctor, you can go directly to a specialist. You can see doctors inside and outside the medical network, but doctors outside the network may have higher out-of-pocket expenses. The premium is higher.

⚠️Starting in 2019, the benefits of the California PPO plan have been greatly reduced! In the past, you could enjoy the same benefits such as medical treatment and medication in other states as in the state; but now only emergency care and emergency room visits are covered in other states.

POS (Point-of-service) : A medical insurance plan between HMO and PPO. You must choose a family doctor and get a referral to see a specialist, but you can see doctors outside the network.

EPO (Exclusive Provider Organization) : You can choose and can only choose any doctor within the network, but no referral is required.

FFS (Fee for Service) : Fee for service. The advantage is that it is flexible and does not restrict the choice of hospital or doctor, but you must pay the fee first and then claim a refund from the insurance company. This type of premium is relatively expensive.