How Investopedia Reviews Health Insurance Companies

State Marketplace Cost Data	Weights
30-year-old individual: Average Premiums	7%
30-year-old individual: Average Medical Deductible	4%
30-year-old individual: Average Medical Out-of-Pocket Maximum	2%
2 40-year-old adults with 2 kids: Average Premiums	5%
2 40-year-old adults with 2 kids: Average Medical Deductible	4%
2 40-year-old adults with 2 kids: Average Medical Out-of-Pocket Maximum	4%
Doctor Visits (Primary and Specialist Copays)	0%
Drug Costs (Drug Tier Copays)	0%
Total	26%

Federal Marketplace Costs

The Qualified Health Plan (QHP) Landscape File, downloaded from HealthCare.gov, is a data file that contains information on certified health insurance plans offered through the Federal Marketplace, also known as the Federal Exchange. This is distinct from individual state marketplaces in that all aspects of shopping for health insurance, such as eligibility, enrollment, and plan selection, are managed by the federal government. Individuals living in any of these states must purchase their plans through state-specific websites; all other states provide coverage options through HealthCare.gov. There are 31 states that offer coverage through the federal Marketplace for 2025 (29 use the federal Marketplace on HealthCare.gov, and two, Arkansas and Oregon, oversee their own marketplaces while still using HealthCare.gov).

The QHP File is a spreadsheet that contains data on 106,427 Exchange plans offered through all states on the Federal Marketplace. Each row contains information on plan features—such as metal tier, plan type, and dental benefits—as well as cost-sharing information, like premiums, deductibles, and out-of-pocket maximum amounts across various ages and family sizes.

Monthly Premiums

Premiums are monthly costs paid to the health insurance company to maintain coverage. We calculated the average monthly premium for each company across every plan they offered in 31 Federal Marketplace states. Specifically, we calculated these averages across the following personas:

• One 30-year-old individual
• Two 40-year-old adults with two kids

We scored Federal Marketplace premiums on a continuous scale from 0 to 1, where the company with the highest monthly cost received a score of 0, and the one with the lowest a score of 1. Of the companies we reviewed, Anthem had the lowest average monthly premium for individuals ($428.43), and Kaiser had the lowest for families ($1,513.09). On the other end, Blue Cross Blue Shield (excluding Anthem) had the highest average premiums for individuals ($561.47), as well as for families ($2,015.45).

Medical Deductible

A medical deductible is the amount you pay for covered health care services before your insurance plan starts to share costs. Some plans may have a separate drug deductible that you’ll need to pay for your medications, while others will combine your drug and medical deductibles. We calculated the average medical deductible for each company across every plan they offered in 31 Federal Marketplace states. Specifically, we calculated the average medical deductible for both individuals and families.

We scored Federal Marketplace medical deductibles on a continuous scale from 0 to 1, where the company with the highest amount received a score of 0, and the one with the lowest a score of 1. Of the companies we reviewed, UnitedHealthcare had the lowest average medical deductible for individuals ($2,824.47) and families ($5,648.93). On the other end, Aetna had the highest average medical deductible for individuals ($5,879.52) and families ($11,759.05).

Medical Out-of-Pocket Maximum

A medical out-of-pocket maximum is the highest amount of money you’ll have to pay for covered health care services in a plan year. Once you reach your out-of-pocket maximum, your health plan will pay 100% of covered health care costs for the rest of the plan year. Some plans may have a separate out-of-pocket maximum for drugs, while others will combine it with your medical costs. For each company, we calculated the average medical out-of-pocket maximum across every plan they offered in 31 Federal Marketplace states. Specifically, we calculated this average for both individuals and families.

We scored Federal Marketplace medical out-of-pocket maximums on a continuous scale from 0 to 1, with the company with the highest amount receiving a score of 0 and the one with the lowest a score of 1. Of the companies we reviewed, Ambetter had the lowest average out-of-pocket maximum for individuals ($6,646.60) and families ($13,293.21). On the other end, Cigna had the highest average medical out-of-pocket maximum for individuals ($7,415.65) and families ($14,831.30).

State Marketplace Costs

State marketplaces provide states with more control over coverage options and eligibility within their jurisdictions and the ability to tailor plans to suit the needs of their residents better. Unlike the Federal Marketplace, where plan options across the 31 participating states are consolidated on the QHP Landscape File or HealthCare.gov plan finder tool, each state marketplace has its own website through which residents can shop and enroll in health coverage. There are 20 states with their own marketplaces for 2025.

Without a data file that consolidated plan information across state marketplaces, we wanted to approximate the average costs for each company across the remaining 20 states not on the federal exchange. Out of these 20, we gathered quotes from the following ZIP codes across five states: 

• 90011: Los Angeles County, California
• 07104: Newark, New Jersey
• 30369: Fulton County, Georgia
• 19120: Philadelphia, Pennsylvania
• 80013: Aurora County (Denver), Colorado

These states were selected based on their high enrollment in exchange plans in 2024. In situations where companies did not offer plans in one or more of these ZIP codes, we substituted the following until we gathered a total of five quotes:

• 22206: Arlington County, Virginia
• 98115: Seattle, Washington
• 06010: Hartford County, Connecticut
• 89108: Las Vegas, Nevada

In each state the company sells plans, we collected quotes for two plans:

• Silver plan with the lowest monthly premium
• Silver plan with the lowest out-of-pocket maximum

We then specifically collected the following criteria:

• Monthly premium
• Medical deductible
• Medical out-of-pocket maximum
• Primary care copay
• Specialist care copay
• Drug copays (Generic, Preferred, Non-Preferred Brand, Specialty tiers)

We used the following two personas:

• 30-year-old individual making $100,000 per year
• Two 40-year-old adults with two children (ages 5 and 10), with a household income of $200,000 per year

Once this data was gathered for individuals and families across each of the 5 states, we aggregated it to get an approximation of state marketplace costs.

Monthly Premiums

Premiums are monthly costs paid to the health insurance company to maintain coverage. We calculated the average monthly premium for each company across the states in which we collected quotes. We calculated different averages for individuals (30-year-old making $100,000) and families (two 40-year-old adults making $200,000 with two children). 

We scored state marketplace premiums on a continuous scale from 0 to 1, where the company with the highest monthly cost received a score of 0, and the one with the lowest a score of 1. Of the companies we reviewed, Molina had the lowest average monthly premium for individuals ($395.54) and families ($1,423.65). On the other end, Blue Cross Blue Shield (excluding Anthem) had the highest average premiums for individuals ($593.61), as well as for families ($2,115.05).

Medical Deductible

A medical deductible is the amount you pay for covered health care services before your insurance plan starts to share costs. Some plans may have a separate drug deductible that you’ll need to pay for your medications, while others will combine your drug and medical deductibles. We calculated the average medical deductible for individuals and families across the five aforementioned state marketplaces.

We scored state marketplace medical deductibles on a continuous scale from 0 to 1, with the company with the highest amount receiving a score of 0 and the one with the lowest a score of 1. Of the companies we reviewed, Blue Cross Blue Shield (excluding Anthem) had the lowest average medical deductible for individuals ($2,428) and families ($4,530). Conversely, Cigna had the highest average medical deductible for individuals ($5,167) and families ($12,500).

Medical Out-of-Pocket Maximum

A medical out-of-pocket maximum is the highest amount you’ll have to pay for covered health care services in a plan year. Once you reach your out-of-pocket maximum, your health plan will pay 100% of covered health care costs for the rest of the plan year. Some plans may have a separate out-of-pocket maximum for drugs, while others will combine it with your medical costs. For each company, we calculated the average medical out-of-pocket maximum across our sample for state marketplaces. Specifically, we calculated this average for both individuals and families.

We scored state marketplace medical out-of-pocket maximums on a continuous scale from 0 to 1, with the company with the highest amount receiving a score of 0 and the one with the lowest a score of 1. Of the companies we reviewed, Ambetter had the lowest average out-of-pocket maximum for individuals ($7,635) and families ($13,820). Conversely, Cigna had the highest average medical out-of-pocket maximum for individuals ($8,904) and families ($17,458).

Copays

Another important aspect to consider when selecting a health insurance plan is the copays or coinsurance associated with doctor visits and purchasing medications. Copays are a fixed dollar amount for a covered service, while coinsurance refers to a percentage of the cost of a covered service you are responsible for. Plans will specify whether certain copay/coinsurance fees kick in from day one of your policy, or only after you have paid your deductible. If it’s the latter, you will be responsible for 100% of the cost of the covered service until the specified amount has been met.

As we were collecting quotes across the state marketplaces, we noticed that copays and coinsurance for doctor visits and drug tiers fell under one of these three categories:

• Flat copay or coinsurance (before deductible)
• Flat copay after deductible
• Coinsurance after deductible

For the purpose of our review, we considered any copay or coinsurance before the deductible to be the most desirable pricing model within plans, as insurance companies will share the financial burden of any care or prescription that you need from the start of your policy. After this, we determined that the next best option would be a flat copay amount after your deductible has been met, as opposed to coinsurance after the deductible; given that medical expenses can range in cost, a flat copay offers more predictability, stability, and transparency in the long run as compared to coinsurance. 

We devised a scoring structure to reflect this logic, as shown below:

• Flat copay or coinsurance (before deductible): Scores between 0.8 and 1, where the highest flat copay/coinsurance before the deductible receives a score of 0.8, and the lowest a score of 1
• Flat copay after deductible: Scores between 0.4 and 0.79, where the highest flat copay after the deductible receives a score of 0.4, and the lowest a score of 0.79

Coinsurance after deductible: Scores between 0 and 0.39, where the highest coinsurance after the deductible receives a score of 0, and the lowest a score of 0.39

Doctor Visits

We gathered copayment data across two types of doctor visits: primary and specialist care visits. This could be a flat copay or coinsurance before or after the deductible. If a company offered the same type of payment structure across all five state marketplaces, we only calculated an average amount across that specific structure. If a company offered different copayment structures across various plans in the five states, we then calculated averages for all applicable criteria. Once we did this, we applied the following scoring structure for each primary care copay category:

• Flat copay or coinsurance (before deductible): Scores between 0.8 and 1, where the highest flat copay/coinsurance before the deductible receives a score of 0.8, and the lowest a score of 1
• Flat copay after deductible: Scores between 0.4 and 0.79, where the highest flat copay after the deductible receives a score of 0.4, and the lowest a score of 0.79
• Coinsurance after deductible: Scores between 0 and 0.39, where the highest coinsurance after the deductible receives a score of 0, and the lowest a score of 0.39

Then, for each of the two doctor visit types (primary and specialist), we took the average across all the individual copay category scores to come up with the following 

• Primary Care Copay Cumulative Score: Cigna received the highest cumulative score of 1, and UnitedHealthcare received the lowest at 0.46
• Specialist Care Cumulative Score: Molina received the highest cumulative score of 0.95, Ambetter received the lowest score of 0.4

We then took the average of the Primary Care Copay Cumulative Score and the Specialist Care Cumulative Score to get another criteria we called Doctor Visits Score. Cigna had the highest Doctor Visits score of 0.96, and UnitedHealthcare had the lowest of 0.45.

Drug Copays

We gathered copayment data across four drug tiers: generic, preferred, non-preferred, and specialty. Similar to doctor visit copays, this could either be a flat copay or coinsurance before the deductible or after. We followed the same methodology for this category as we did for Doctor Visits. We applied the following scoring structure for each drug tier category.

• Flat copay or coinsurance (before deductible): Scores between 0.8 and 1, where the highest flat copay/coinsurance before the deductible receives a score of 0.8, and the lowest a score of 1
• Flat copay after deductible: Scores between 0.4 and 0.79, where the highest flat copay after the deductible receives a score of 0.4, and the lowest a score of 0.79
• Coinsurance after deductible: Scores between 0 and 0.39, where the highest coinsurance after the deductible receives a score of 0, and the lowest a score of 0.39

For each drug tier, we took the average across all the individual copay category scores to come up with the following:

• Generic Tier Cumulative Score: Cigna received the highest score (0.98), and Oscar Health received the lowest (0.42)
• Preferred Tier Cumulative Score: Aetna received the highest score (0.95), and Oscar Health received the lowest (0.44)
• Non-Preferred Tier Cumulative Score: Anthem received the highest score (0.72), and Oscar Health received the lowest (0.48)
• Specialty Tier Cumulative Score: Kaiser received the highest score (0.54), and Aetna received the lowest (0.29)

We then averaged all the drug tier cumulative scores to get another criterion we call Drugs Cumulative Score. Aetna had the highest score of 0.69, and Oscar Health had the lowest score of 0.41.

Criteria That Did Not Receive a Score

Network Size

This measure refers to the number of health care providers included in the health plan’s network, such as doctors, hospitals, and pharmacies. A larger network typically offers more choices for patients. We collected data on the size of the provider network for each company. However, because it came directly from the companies, and we weren’t able to independently verify it, we chose not to score it.

Articles That Use Our Methodology

We have many articles about the best health insurance companies for specific products or to meet the needs of particular readers. The research conducted and data collected to create this methodology have been used to compile our list of the Best Health Insurance Companies for 2025. Other articles that list the best health insurance companies for certain products or readers (for example, Best Health Insurance for the Self-Employed, Best Health Insurance Companies in Texas, Best Health Insurance Companies in Florida, and Best Affordable Health Insurance Companies) rely on information collected as part of the grading process described here. But selections and order of providers are based on additional product-specific criteria plus subjective insights from our editors and industry experts.

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