It’s that time of year again: open enrollment. With it comes a lot of questions: Do I go with an HMO or a PPO? Do I need an FSA or an HSA? What’s my deductible again?

It’s very confusing, but one thing is clear: The cost of your health insurance is likely going up. Premiums are growing whether you get your insurance through work, the Affordable Care Act marketplaces, or Medicare.

Of course, medical insurance has been getting more expensive for years, but KFF chief Washington correspondent Julie Rovner told me the problem is now getting worse. “We’ve had bigger inflationary spikes, particularly in the early 2000s, but for the last 15 years or so, health care costs have been rising but not terribly fast,” she said. “They seem to be accelerating again now.”

Why do our premiums keep rising? And what can we do about it? Rovner answers those questions on the latest episode of Explain It to Me, Vox’s weekly call-in podcast. Below is an excerpt of our conversation, edited for length and clarity. You can listen to the full episode on Apple Podcasts, Spotify, or wherever you get podcasts. If you’d like to submit a question, send an email to askvox@vox.com or call 1-800-618-8545.

Why are premiums going up so quickly now?

Well, there’s a bunch of reasons, but they come down to two things: price and utilization. Utilization is how many health care services people use. The more services people use, the more the nation’s health care bill goes up. There are a lot of things that are driving expanded use right now. One of them is........

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