A plan with a low monthly premium can cost more when you need care. Comparing health plans means estimating both the regular premium and the amount you might pay when you use covered services.
Know the main cost terms
The premium is what you pay to keep coverage. A deductible is an amount you may pay for covered services before the plan starts sharing certain costs. A copayment is usually a set amount for a service, while coinsurance is a percentage of an allowed cost. Rules vary by plan and service.
An out-of-pocket maximum limits what you pay for covered in-network services in a plan year, under the plan’s rules. Premiums, uncovered services, and some out-of-network costs generally do not count toward that limit. Read the plan’s Summary of Benefits and Coverage for the exact details.
Test a realistic year
List the doctors, medicines, and services you expect to use. Check provider networks and the drug list directly with the plan. Then compare the yearly premium plus likely care costs, as well as the amount you could have to pay in a high-use year. Check referral and prior-authorization requirements, too.
Benefits and eligibility change. Confirm current details with the insurer or your official enrollment source before choosing a plan.
Further reading: HealthCare.gov guide to total costs and out-of-pocket maximum glossary.
This is general educational information for U.S. readers. Product terms and state rules vary. Check current documents and ask a qualified professional when you need personal advice.