Health insurance costs: what to compare beyond the premium

Begin with the monthly premium

The premium is what you pay for coverage each month. It is a useful starting point, but it does not describe every cost you may pay when you use care.

Review the costs when you use care

Compare the deductible, copayments, coinsurance, and out-of-pocket limit shown in the plan documents. Consider how those terms relate to the care you expect to use. Read the Summary of Benefits and Coverage for a structured overview of a plan.

Check providers and prescriptions

Look at whether your doctors, facilities, and prescriptions are included. Review the actual provider directory and drug list, and verify important details with the insurer and provider before enrolling.

Put the comparison together

A useful discussion includes your monthly budget and potential costs during the year. Bring the plan documents and the questions that matter to your household so we can work through them together.

Questions to put beside each plan

• What is the annual premium, and what might I pay in a year with more medical care?
• Which services have a deductible, copayment, or coinsurance? Are prescription costs handled separately?
• Are my doctors, hospitals, and medicines covered under this exact plan?
• What care needs prior authorization or a referral, and what happens outside the network?
• Does the out-of-pocket limit apply to the services I expect to use? Premiums and noncovered services are separate costs.

Further reading

• HealthCare.gov: Comparing plans
• HealthCare.gov: Total health care costs

This guide is general information. Plan and contract details vary; review the documents that apply to your situation.