How Much Does Affordable Care Act (Obamacare) Insurance Cost?
Key takeaways:
Affordable Care Act (ACA) health plans require you to pay a monthly premium, which may be reduced by a premium subsidy — also called a premium tax credit.
New legislation means that 4 out of 5 people in the 2025 coverage year will be able to find a plan on the marketplace for $10 or less per month.
ACA insurance plans may require out-of-pocket costs such as meeting a deductible as well as copayments or coinsurance when you access care.
If you qualify for additional cost savings and select a silver plan, you can receive help paying for your deductible and copays. You will also have a lower out-of-pocket maximum.
Table of contents
The Affordable Care Act (ACA) — also known as Obamacare — is the 2010 comprehensive health-reform law that expanded health insurance options in the U.S.
ACA marketplaces have extended health insurance coverage to millions of people. The law also led to Medicaid expansion in most states. This means there are fewer uninsured people. And those with coverage have more options for healthcare.
Having a health insurance plan typically means paying upfront with a monthly premium. Accessing care can lead to more out-of-pocket costs for deductibles as well as your share of payments for healthcare visits, tests, and medications.
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Keep reading to learn more about the costs of ACA insurance.
What is the total financial cost of an ACA insurance plan?
It’s important to consider the complete financial picture when thinking about what you will pay for an ACA health insurance plan. This is called the total cost estimate.
The total cost estimate is the sum of the premium, deductible, and out-of-pocket costs when you access care.
Your premium is the monthly bill for your health insurance plan.
Your deductible is triggered when you need care. This is the amount you pay before your insurance begins to share costs, except for when you access preventive health services. For instance, if you have a $1,000 deductible, you will pay $1,000 out of pocket before your insurance company begins to pay its part.
Other out-of-pocket costs include copayments and coinsurance. These are payments you make each time you get healthcare, excluding preventive health services. A copayment, or copay, is a fixed amount that you pay after meeting your deductible. Coinsurance is a percentage of the cost of a covered health service after you have met your deductible.
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Your out-of-pocket costs have a limit with ACA plans. The out-of-pocket maximum is the most you must pay for covered services in a plan year. After your deductible, copays, and coinsurance reach this amount, all covered services in a plan year are paid 100% by your health plan.
The out-of-pocket limit in 2025 for marketplace plans is $9,200 for an individual and $18,400 for a family. It's lower if you qualify for cost-sharing reductions, which we will discuss later.
What factors contribute to the cost of an ACA plan?
The cost of your ACA health insurance plan depends on many factors, including:
Your household size — whether you apply as an individual or a family
Your income
Where you live — often down to the county
The type of plan you choose among the metal tiers or a catastrophic plan
The subsidies, also known as premium tax credits and cost-sharing reductions, you receive
ACA plans are organized into four metal tiers: bronze, silver, gold, and platinum.
Bronze plans have the lowest monthly premiums but the highest out-of-pocket costs when you receive care. Platinum plans have the highest monthly costs but the lowest expenses when you access care.
How much in monthly premiums can you expect to pay with Obamacare?
The premium tax credit is based on your estimated income in a coverage year. If your actual income is higher or lower, your premium tax credit could be adjusted.
Families within certain income limits — those earning 100% to 400% of the federal poverty level, and sometimes more — will qualify for savings on monthly premiums.
What you pay each month also depends on the plan you select. A KFF national analysis of marketplace plans for a 40-year-old person found that the average premium (without subsidies) for a benchmark silver plan in 2025 is $497. The price ranges from a low of $325 in New Hampshire to a high of $1,277 in Vermont
Thanks to the American Rescue Plan Act of 2021 and the Inflation Reduction Act of 2022, financial assistance for ACA premiums continues in 2025. Generous subsidies mean that 4 out of 5 people will be able to find a plan that costs $10 or less per month.
The KFF analysis applied nationwide to all metal tiers, except platinum, found the average premium amounts listed in the chart below.
| Plan Category | 2025 cost |
|---|---|
| Average lowest-cost bronze premium | $381 |
| Average lowest-cost silver premium | $486 |
| Average benchmark silver premium | $497 |
| Average lowest-cost gold premium | $507 |
According to KFF, 2025 premium tax credits fully cover the cost of a benchmark silver plan for consumers with incomes up to 150% of the federal poverty level. These consumers also receive extra savings known as "cost-sharing reductions" — which are only available when enrolled in a silver plan — that greatly reduce deductibles and copays to costs similar to platinum plans. (More on that later.)
How can cost-sharing reductions reduce your Obamacare expenses?
You may qualify for extra savings if you select a silver plan. These cost-sharing reductions will help you pay less out of pocket when you receive care. These savings apply to your deductible, copays, coinsurance, and out-of-pocket maximum.
Use this income tool to find out if your estimated 2025 income falls within the range to qualify for cost-sharing reductions. If you are eligible, you will find out exactly how much you’ll save when you apply for ACA coverage and shop for a silver plan.
Enrolling in a silver plan and qualifying for cost-sharing reductions can:
Lower your deductible: Let’s say your deductible is $750. That means you have to pay the first $750 in medical costs (except for preventive services) before the insurance plan begins to pay. If you qualify for cost-sharing savings, your deductible could be reduced to $300 or $500, depending on your income.
Lower your copays and coinsurance: This is what you pay each time you receive a medical service. This means if your copay under a silver plan is $30, cost-sharing reductions could drop that to $15 or $20.
Lower your out-of-pocket maximum: This is the total amount you will pay out of pocket in a coverage year. Let’s say the usual out-of-pocket maximum limit for your silver plan is $5,000. Under extra savings, that could be reduced to $3,000.
Certain special populations have ACA coverage but pay nothing out of pocket if they access care with certain healthcare professionals and at certain facilities. This is possible through a zero-cost-sharing plan.
These zero-cost-sharing plans are available to members of federally recognized tribes and Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders. Eligible consumers also must have incomes 100% to 300% of the federal poverty level to qualify for premium tax credits. ACA enrollees in this group do not pay deductibles, copays, or coinsurance when receiving care from an Indian healthcare provider. They also have no out-of-pocket costs when getting essential health benefits through an ACA plan on any metal level.
You can estimate your costs using this ACA health insurance marketplace calculator.
How do deductibles work under the Affordable Care Act?
A deductible is the amount that you pay for covered medical services before your health plan starts pitching in.
Here are a few things to know about your deductible:
Generally, health plans with higher premiums have lower deductibles. Plans with lower premiums have higher deductibles.
After you meet your deductible, all covered medical services you receive should only require a copay or coinsurance (until you reach your out-of-pocket maximum). Your insurance plan will pay the rest.
When you access preventive services — including well visits, certain screenings, and vaccinations — you do not have to pay toward your deductible or any copay or coinsurance.
Your deductible will be reduced or eliminated if you qualify for cost-sharing reductions or a zero-cost-sharing plan.
How do subsidies reduce your cost for ACA coverage?
Most often, ACA subsidies are provided in the form of an advance premium tax credit. This amount is paid to your insurance plan throughout the year and reduces your monthly bill. Because this credit is based on estimated income, your final income will determine whether you have to pay the government at tax time. If you were eligible for more than you received, you will get the difference refunded. To make sure your subsidies are accurate, report income changes throughout the year.
You also have the option to pay the premium in full each month and receive a credit on your taxes for the coverage year.
The bottom line
Accessing care covered by Affordable Care Act (ACA) health plans generally requires an upfront payment to have the insurance coverage and out-of-pocket costs when you receive services. The total costs for an ACA plan include a monthly premium, then meeting a deductible — and paying coinsurance and copays — when you receive care. A premium tax credit can take monthly costs to zero for some consumers. Those who qualify for cost-sharing reductions and select a silver plan may qualify for additional savings on deductibles, copays, coinsurance, and their out-of-pocket maximum.
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References
Centers for Medicare and Medicaid Services. (2024.). Marketplace 2025 open enrollment fact sheet.
HealthCare.gov. (n.d.). Advance premium tax credit (APTC).
HealthCare.gov. (n.d.). Affordable Care Act (ACA).
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HealthCare.gov. (n.d.). Copayment.
HealthCare.gov. (n.d.). Deductible.
HealthCare.gov. (n.d.). Federal poverty level.
HealthCare.gov. (n.d.). Health benefits and coverage: Preventive health services.
HealthCare.gov. (n.d). Out-of-pocket maximum/limit.
HealthCare.gov. (n.d.). Premium.
HealthCare.gov. (n.d.). Premium tax credit.
HealthCare.gov. (n.d.). Saving money on health insurance: Cost-sharing reductions.
HealthCare.gov. (n.d.). Saving money on health insurance: Income level and savings.
HealthCare.gov. (n.d.). Total cost estimate (for health coverage)
HealthCare.gov. (n.d.). Your total costs for health care: Premium, deductible and out-of-pocket costs.
HealthCare.gov. (n.d.). Zero cost sharing plan.
KFF. (2024.). Average marketplace premiums by metal tier, 2018-2025.
KFF. (2024). Expanding health care reform: Questions about health insurance subsidies.
KFF. (2024.). Health insurance marketplace calculator.
KFF. (2024). Status of state Medicaid expansion decisions.
KFF. (n.d.). What is a catastrophic health plan?
