Health Insurance
Plans, Costs & How to Choose the Right Plan

While the federal individual mandate penalty was removed in 2019, several states (including California, Massachusetts, New Jersey, Rhode Island, and Vermont) still require residents to have health insurance or pay a state penalty. Beyond legal requirements, health insurance protects you from catastrophic medical bills — a single emergency hospitalisation can cost $30,000 or more without coverage.

Your premium is what you pay monthly to maintain coverage. Your deductible is what you pay out of pocket each year before your insurer starts covering costs. A copay is a fixed amount you pay for a specific service (such as $25 per doctor visit). All three affect your total annual cost — a low premium plan often has a high deductible, so your real cost depends on how much care you actually use.

It depends on the plan type. PPO and POS plans allow out-of-network care (at higher cost), so you can generally keep an existing doctor even if they are not in-network. HMO and EPO plans restrict you to in-network providers — if your doctor is not in the network, you would need to pay full cost out of pocket or switch providers. Always verify your doctor’s network status before enrolling.

The standard ACA open enrollment period runs from November 1 to January 15 each year (dates vary slightly by state). Outside this window, you can only enrol if you experience a qualifying life event — such as losing job-based coverage, getting married, having a child, or moving to a new state. These events trigger a Special Enrollment Period (SEP) during which you can sign up within 60 days.