Health insurance is the cost that catches most new arrivals in America completely off guard.
An unsubsidised family plan can pass $1,500 a month. A single emergency room visit without cover routinely runs into five figures.
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Yet millions of Americans pay under $200 a month, and many pay nothing at all.
The difference is almost never the plan. It is whether you claimed the subsidy you were entitled to.
This guide covers what plans actually cost in 2026, which states are cheapest, and how to enrol.
Why Most People Overpay
The sticker price of a health plan and the price you pay are rarely the same number.
The premium tax credit
The federal government pays part of your premium directly to the insurer if your income falls within a qualifying band.
This is applied at the point of purchase, not refunded a year later. Your monthly bill is simply lower.
Who qualifies in 2026
- Individuals earning roughly $15,000 to $60,000 a year
- Households of four earning roughly $31,000 to $124,000
- Anyone not offered affordable cover through an employer
- Lawfully present immigrants, including many visa holders
The mistake that costs the most
Buying directly from an insurer's own website instead of through the official marketplace.
Plans bought outside the marketplace are not eligible for the subsidy. The same plan can cost three times more through the wrong door.
What Under $200 a Month Actually Buys
Expectations matter. At this price you are looking at Bronze and Silver marketplace plans.
Included in every marketplace plan by law
- Emergency services
- Hospitalisation
- Prescription drugs
- Laboratory tests
- Preventive care and screenings at no extra cost
- Maternity and newborn care
- Mental health and substance use treatment
What you trade away at this price
- Higher deductibles, often $6,000 or more before most cover begins
- Narrower doctor and hospital networks
- Higher copays for specialist visits
- Limited or no out-of-network cover
A Bronze plan protects you from catastrophe. It does not make routine care free.
The Cheapest Plan Types in 2026
1. Bronze Marketplace Plans
Typical monthly premium after subsidy: $0 – $120
Annual deductible: $6,000 – $9,200
The default choice for healthy adults who want protection against disaster rather than help with everyday costs.
What works well
- Lowest premiums of any full plan
- Free preventive care regardless of deductible
- Out-of-pocket costs capped by law
- Many qualify at literally $0 after subsidy
What to watch
- Very high deductible before most cover starts
- Specialist copays can be steep
- Networks are often narrow
Best for people under 40 with no ongoing conditions and some savings to cover a deductible.
2. Silver Marketplace Plans with Cost-Sharing Reductions
Typical monthly premium after subsidy: $50 – $190
Annual deductible: $800 – $3,500
The most misunderstood and most valuable option for lower earners.
What works well
- Cost-sharing reductions slash the deductible dramatically
- Often better total value than Bronze despite higher premium
- Lower copays for doctor visits
- Available to those earning under roughly 250% of the federal poverty level
What to watch
- Only available on Silver tier, nowhere else
- Requires accurate income reporting
- Premium is higher than Bronze before subsidy
If your income qualifies you for cost-sharing reductions, Silver almost always beats Bronze. Most people never check.
3. Medicaid
Typical monthly premium after subsidy: $0
Annual deductible: $0
Free or near-free cover for the lowest income bands, run by each state.
What works well
- No premium in most states
- Minimal or no copays
- Comprehensive cover including dental in many states
- Enrolment open all year, not just during open enrolment
What to watch
- Eligibility varies enormously by state
- Ten states have not expanded eligibility
- Some immigration statuses face a five-year waiting period
Always check Medicaid eligibility before buying anything. Roughly a quarter of people who buy marketplace plans would have qualified for free cover.
4. Catastrophic Plans
Typical monthly premium after subsidy: $90 – $180
Annual deductible: $9,200
Restricted to those under 30, or people granted a hardship exemption.
What works well
- Very low premiums
- Three primary care visits covered before deductible
- Full protection against major medical events
What to watch
- Subsidies cannot be applied to these plans
- Deductible is extremely high
- Age restricted
Usually worse value than a subsidised Bronze plan. Check Bronze first.
5. Short-Term Limited Duration Insurance
Typical monthly premium after subsidy: $80 – $200
Annual deductible: $2,500 – $10,000
Gap cover between jobs or while awaiting other coverage.
What works well
- Cheap and fast to activate
- Flexible durations
- No open enrolment window
What to watch
- Can refuse you for pre-existing conditions
- Not required to cover prescriptions or maternity
- Does not satisfy coverage requirements in several states
- No subsidy available
Treat as a genuine last resort. These plans can decline claims in ways marketplace plans legally cannot.
Average Monthly Premiums by State
Figures below are typical post-subsidy Bronze premiums for a 30-year-old earning around $35,000 in 2026.
| State | Typical monthly premium | Notes |
|---|---|---|
| Maryland | $0 – $45 | Among the most competitive markets |
| Virginia | $0 – $60 | Strong insurer competition |
| New Hampshire | $10 – $70 | Consistently low premiums |
| Michigan | $15 – $75 | Many carriers on the exchange |
| Pennsylvania | $20 – $85 | State-run marketplace |
| Texas | $25 – $95 | Low premiums, no Medicaid expansion |
| Georgia | $30 – $100 | Improved competition since 2024 |
| Florida | $30 – $110 | Largest marketplace enrolment in the country |
| Ohio | $35 – $115 | Wide network variation by county |
| New York | $50 – $175 | Higher premiums, stronger consumer protections |
| Wyoming | $90 – $200 | Least competitive market nationally |
How Your Income Changes the Price
The subsidy scales with income. Small changes move the number significantly.
| Annual income (single) | Typical Bronze premium | Typical Silver premium |
|---|---|---|
| Under $15,000 | Likely Medicaid eligible | Likely Medicaid eligible |
| $15,000 – $22,000 | $0 | $0 – $30 |
| $22,000 – $30,000 | $0 – $30 | $40 – $90 |
| $30,000 – $40,000 | $20 – $85 | $90 – $170 |
| $40,000 – $55,000 | $70 – $160 | $160 – $290 |
| Over $60,000 | Full price, often $350+ | Full price, often $450+ |
Enrolling Without a Long US History
This is the section most guides skip, and it is where newcomers get stuck.
What you actually need
- Proof of lawful presence, such as a visa, green card or work permit
- A Social Security number if you have one
- An estimate of this year's income
- A US address
If you do not yet have a Social Security number
You can still apply. The marketplace accepts an application without an SSN if you are not eligible for one, and will ask for document numbers from your immigration paperwork instead.
If you have applied for an SSN but not received it, you may enrol and supply the number later.
Special enrolment periods
You do not have to wait for the annual open enrolment window if you have recently:
- Moved to the United States
- Lost other health coverage
- Changed immigration status
- Married, divorced, or had a child
- Had a significant change in income
Each of these opens a 60-day window to enrol.
Six Ways to Cut the Price Further
- Report income accurately, not optimistically. Overstating income reduces your subsidy and you will not get it back until you file taxes.
- Check Medicaid first. Free beats cheap, and many who qualify never apply.
- Compare Silver against Bronze properly. Cost-sharing reductions can make Silver cheaper overall despite a higher premium.
- Update your income mid-year if it drops. Your subsidy adjusts immediately.
- Use the official marketplace, not a broker site. Broker sites often show non-subsidised plans first.
- Check county-level pricing. Premiums vary within a state, sometimes substantially between neighbouring counties.
Mistakes That Cost People Thousands
Buying outside the marketplace
No subsidy is available on plans bought directly from an insurer. This single error is the most expensive one people make.
Choosing on premium alone
A $0 premium plan with a $9,000 deductible can cost far more across a year than a $90 plan with a $1,500 deductible.
Ignoring the network
Check that a hospital near your actual address is in network. Cheap plans often exclude the nearest facility.
Missing open enrolment
Outside a special enrolment period, missing the window leaves you uninsured for the rest of the year.
Assuming immigrants are ineligible
Lawfully present immigrants qualify for marketplace plans and subsidies. Many never apply because they assume they cannot.
Common Questions
Can I get health insurance without a Social Security number?
Yes, if you are lawfully present and not eligible for an SSN. The marketplace will use your immigration document numbers instead.
Is $0 a month real?
Yes. In many states a Bronze plan costs nothing after subsidy for those earning under roughly $22,000. You still face deductibles and copays.
What happens if my income changes during the year?
Report it. Your subsidy recalculates immediately. If you do not report an increase, you may owe money back at tax time.
Does insurance cover me immediately?
Coverage usually begins on the first day of the month after you enrol and pay the first premium.
Can I keep my plan if I move states?
No. Plans are state specific. Moving triggers a special enrolment period so you can choose a new one.
What if I cannot afford anything at all?
Check Medicaid, then community health centres, which charge on a sliding scale based on income and treat patients regardless of insurance status.
Your Next Step
Check Medicaid eligibility first, because free beats cheap.
If you do not qualify, go to the official marketplace, enter your real income, and compare Bronze against Silver with cost-sharing reductions applied.
Check that a hospital near your address is in network before you enrol.
Most people who pay over $200 a month are simply in the wrong plan, bought through the wrong channel, with the wrong income on file. All three are fixable in an afternoon.
State Marketplaces vs the Federal Marketplace
Not every state uses the same enrolment system, and it changes where you apply.
States running their own marketplace
California, Colorado, Connecticut, Idaho, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Vermont, Virginia, Washington and Washington DC each run their own exchange.
These often have longer enrolment windows and additional state-level subsidies stacked on top of the federal ones.
Everywhere else
All remaining states use the federal marketplace. Same rules, same subsidies, one central application.
Why it matters for price
Several state marketplaces add their own premium assistance. In those states your final cost can be materially lower than the federal subsidy alone would produce.
Understanding Deductibles, Copays and the Out-of-Pocket Maximum
Three numbers decide what you actually pay in a bad year. Most people only look at one.
The deductible
What you pay yourself before the plan starts sharing costs. Preventive care is exempt and covered from day one.
The copay and coinsurance
After the deductible, you pay a fixed amount per visit or a percentage of the bill. Typically 20% to 40% on cheaper plans.
The out-of-pocket maximum
The legal ceiling on what you can spend in a year. Once reached, the plan pays everything else. In 2026 this is capped at roughly $9,200 for an individual.
How to compare two plans properly
- Add twelve months of premium to the deductible for a realistic bad-year cost
- Compare that total, not the monthly figure
- Check the out-of-pocket maximum, which is your true worst case
- Confirm your regular medications are on the plan's drug list
What to Do If You Get a Surprise Bill
Medical billing errors are extremely common in the United States, and most bills are negotiable.
- Request an itemised bill. Never pay a summary total without seeing line items.
- Check every line against your visit. Duplicate charges are routine.
- Ask about the No Surprises Act. It protects you from most out-of-network emergency charges.
- Ask for the cash price. It is frequently lower than the insured rate.
- Request a payment plan. Most hospitals offer interest-free instalments.
- Apply for financial assistance. Non-profit hospitals are legally required to offer charity care programmes.