How to choose a health insurance plan

Start with the subsidy estimate, then compare total expected cost — premium, deductible, copays and drugs — inside the network.

1. Get the subsidy estimate first

The list premiums on this site are before tax credits. Enter income and household size at HealthCare.gov (or your state marketplace) to see the real monthly price. Do this before comparing plans: the credit changes the ranking, and silver plans can get cost-sharing reductions at lower incomes.

2. Compare total cost

Premium × 12 + expected deductible use + copays + prescriptions. A bronze plan with a $7,000 deductible can be the right choice for someone who rarely uses care; a silver plan with a lower deductible often wins for anyone who will use care regularly.

3. Check the network

HMO, EPO, PPO and POS plans differ in whether you need referrals and whether out-of-network care is covered. Verify your doctors, hospital and preferred pharmacy are in-network for the exact plan — networks are plan-specific, not insurer-wide.

4. Check prescriptions

Look up each drug on the plan's formulary and check the tier and prior-authorisation rules. A cheap premium is irrelevant if a needed drug costs hundreds a month.

5. Check the out-of-pocket maximum

This is your worst-case yearly exposure for in-network care. A lower premium with a much higher out-of-pocket maximum may not be the safer choice if a hospital stay is likely.

6. Enrol on time

Open enrollment for the next plan year runs November 1 – January 15 on the federal marketplace (with a December 15 deadline for January 1 coverage). Outside that window you need a qualifying life event for a special enrollment period. Do not let coverage lapse — a gap can delay new coverage.

Written and maintained by the US Health Insurance Marketplace data team · last reviewed 2026-10-24 · sources and methodology.