Employer coverage: the 2025 benchmark

Most insured Americans under 65 get coverage through an employer, and the authoritative measurement is KFF's annual Employer Health Benefits Survey, which for 2025 interviewed 1,862 non-federal public and private firms.

It found average annual premiums of $9,325 for single coverage and $26,993 for family coverage. Family premiums rose 6% and single premiums 5% over the year — against 4% wage growth and 2.7% general inflation, meaning coverage again grew faster than pay.

Those are total premiums, employer plus employee. Workers contributed an average of $1,440 toward single coverage and $6,850 toward family coverage from their own paychecks. The rest is employer contribution, which is real compensation even though it never appears on a payslip.

Two practical consequences. First, the family premium gap is large enough that when both spouses have employer coverage, running the numbers on two single plans versus one family plan is often worth several thousand dollars. Second, your visible payroll deduction is roughly a quarter of what the coverage costs, which is why employer coverage is almost always cheaper than the individual market for anyone who has access to it.

The ACA marketplace in 2026: two changes at once

2026 was an unusually disruptive year for people who buy their own coverage, because two separate things happened simultaneously.

Insurers raised prices sharply. Marketplace insurers filed for an average premium increase of roughly 26% for 2026 — about 30% in states using HealthCare.gov and 17% in state-run marketplaces.

The enhanced premium tax credits expired at the end of 2025. Those credits, enacted in 2021, had increased subsidy amounts and extended eligibility above 400% of the federal poverty level. Their expiry raised what enrollees pay independently of the rate increases.

The combined effect on real household budgets was larger than either change alone. KFF found the average monthly premium payment consumers actually made, net of tax credits, rose 58% — from $113 in 2025 to $178 in 2026.

The impact was uneven. Enrollees with incomes above 400% up to 500% of the federal poverty level, who had gained eligibility under the enhanced credits, were about 3% of 2025 sign-ups but accounted for 27% of the drop in sign-ups from 2025 to 2026, with that group's enrolment falling 44%.

If you buy marketplace coverage and auto-renewed, this is the year to re-shop rather than assume your plan is still the best value at your income.

Calculating your real cost, not your premium

Your total annual spend is the premium plus your cost sharing, and comparing plans on premium alone systematically favours the wrong plan for anyone who uses care.

Do this calculation for each plan you are considering:

  1. Annual premium. Monthly premium × 12, net of any subsidy.
  2. Expected cost sharing in a normal year. Your realistic use — routine visits, prescriptions, one or two specialist appointments — priced against the plan's deductible, copays and coinsurance.
  3. Worst case. Annual premium + the plan's in-network out-of-pocket maximum. This is the most a bad year can cost you, and it is the number that actually measures how much insurance you bought.

Run all three for each plan. A cheaper premium with a $9,000 out-of-pocket maximum and a dearer premium with a $3,000 maximum are different products, and the ranking flips depending on which year you get.

Remember that premiums never count toward the deductible or the out-of-pocket maximum, and that out-of-network care generally does not count toward the in-network maximum at all.

What moves your number up or down

Age. On ACA-compliant individual coverage, insurers may charge older adults up to three times what they charge younger ones, and premiums rise with each year of age.

Location. Rating areas are set within states, and premiums vary substantially between them because provider costs and market competition differ.

Tobacco use. ACA rules permit a surcharge of up to 50%, though some states restrict it.

Household size and who is covered. Individual, individual plus spouse, and family tiers price very differently.

Metal tier. Bronze, Silver, Gold and Platinum describe actuarial value — roughly what share of total costs the plan covers across a standard population. They say nothing about network quality or formulary.

Income, through subsidies. Premium tax credits are calculated against the benchmark silver plan in your area, so the subsidy — and therefore your net cost — changes when the benchmark plan changes, even if your own plan's price did not.

Notably absent from that list: your health status. ACA-compliant plans cannot charge more or deny coverage because of pre-existing conditions.

Ways to lower the cost that are actually available

Check subsidy eligibility with your current income estimate. Premium tax credits are reconciled on your tax return, so an estimate that is too low means repaying part of the credit, and one that is too high means overpaying all year. Update the marketplace when your income changes.

Check cost-sharing reductions. Households below a certain income threshold qualify for reduced deductibles and out-of-pocket maximums, but only on Silver plans. Choosing Bronze forfeits them entirely, which is the most common expensive mistake on the marketplace.

Check Medicaid and CHIP. Eligibility depends on your state and household income, and there is no enrolment window — you can apply at any time.

Consider an HSA-qualified high-deductible plan if you have low predictable utilisation and could absorb the deductible. The triple tax advantage — deductible contributions, tax-free growth, tax-free qualified withdrawals — is real, and unspent balances roll over indefinitely.

Re-shop every open enrollment. Auto-renewal is the default and it is rarely optimal, because the benchmark plan that sets your subsidy changes each year.

A warning about the cheap alternatives. Short-term limited-duration plans, health care sharing ministries and fixed-indemnity products are not ACA-compliant comprehensive coverage. They can exclude pre-existing conditions, cap benefits, and decline to cover categories of care. They are cheaper because they cover less, and the gap shows up exactly when you need the coverage.

Frequently asked questions

Two things happened at once: insurers filed average rate increases of roughly 26%, and the enhanced premium tax credits expired at the end of 2025. KFF found the average net monthly payment rose 58%, from $113 to $178, because the two effects compound.
Only if you use little care and do not qualify for cost-sharing reductions. Those reductions apply exclusively to Silver plans, so a subsidy-eligible household that picks Bronze for the lower premium can end up paying far more in deductibles across the year.
Your in-network deductible, copays and coinsurance for covered essential health benefits. Premiums never count, out-of-network charges generally do not count toward the in-network maximum, and balance-billed amounts and non-covered services do not count at all.
Only with a qualifying life event — losing other coverage, marriage, birth or adoption, or a permanent move, among others — which opens a special enrollment period, usually 60 days. Medicaid and CHIP have no enrolment window and can be applied for at any time.

Sources

Every figure above is drawn from the following publications. Links open on the publisher's own site.

IW

InsureWiseHub editorial team

We write plain-language explainers about U.S. insurance and cite a primary source for every number. We do not sell insurance and we are not paid by insurers. Read our editorial policy.

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