The short answer: for each plan, add up twelve months of premium, then add what you are likely to pay when you use care: the deductible, your copays and coinsurance. Then look at the out-of-pocket maximum, the most you could pay in a hard year. Compare the plans on those totals, not on the monthly price alone.
The numbers that make up a year
- Premium. What you pay every month, whether you use the plan or not. Multiply by twelve.
- Deductible. What you pay before the plan starts sharing costs.
- Copays and coinsurance. Your share of each visit, prescription or bill once the plan is sharing costs.
- Out-of-pocket maximum. The most you pay for covered care in a plan year. Together with the deductible, it decides the most you could pay.
Four steps to compare
- 1. The quiet year. Premium times twelve, plus the checkups and prescriptions you know you will have. This is your floor.
- 2. The expected year. Add the care you already see coming: a specialist you see regularly, a medication you take every month, a procedure you have been putting off.
- 3. The hard year. Premium times twelve plus the out-of-pocket maximum. This is the number to be able to live with.
- 4. Line them up. Put the three totals for each plan side by side. A plan with a low monthly price and a high deductible can win the quiet year and lose the hard one.
Picture it
You sort the list by monthly price and pick the lowest. It feels like the smart move all spring. Then in the summer you need an MRI and a few rounds of physical therapy, and almost all of it lands under the deductible. By fall you have paid more than the plan one row up would have cost you for the whole year, monthly price included.
Now picture the other version. Before you enroll, you write down the care you expect and we run each plan through a quiet year, an expected year and a hard year. The cheapest monthly plan might still win, and then you pick it knowing why. Or the plan one row up does, and you saw it before the MRI, not after.
Three things the totals can hide
- When the deductible resets. A calendar-year deductible resets every January 1, no matter when you enrolled. Starting late in the year? Check the reset date, because it can mean two deductibles in your first twelve months.
- Major medical or limited medical. A limited medical plan pays set amounts up to a cap, so the rest of a large bill can be yours. How to tell the difference.
- Whether your doctors are in the network. The totals assume in-network care. Networks change, so we check your doctors by name at enrollment.
Marketplace or private?
On the Marketplace, Bronze and Silver deductibles can be several thousand dollars, so the hard-year total matters as much as the premium. A subsidised premium is also only part of the real price. Private plans offer options with lower deductibles, copay-based visits or first-day benefits, and for a healthy applicant who gets little or no subsidy, a private plan's full price is often lower. See ACA and private plans side by side.
Want a starting point? The "Am I overpaying?" check compares what you pay now against the plans in our Plan Finder.
This is general education, not tax advice and not a guarantee of coverage or savings. Plan designs, pricing, networks and eligibility depend on your state, your location and underwriting.