Coverage that makes sense for your health and budget.
Premiums are only part of the story. Understanding deductibles, networks and out-of-pocket limits helps you choose a plan you can actually use when you need it.
- Individual, couple and family options
- Compare premiums, deductibles and networks
- Learn how subsidies and enrollment work
Look past the monthly premium
The cheapest plan isn't always the best value. These are the numbers that shape what you actually pay for care.
Check the deductible
This is what you pay for covered care before the insurer starts sharing costs. A higher deductible usually means a lower premium.
Confirm the network
Check that your doctors, hospitals and prescriptions are covered. Out-of-network care can cost far more.
Mind the enrollment window
Open enrollment is limited. A qualifying life event can create a special enrollment period, but deadlines still apply.
How health insurance plans are structured
Most individual and family plans sold through the Health Insurance Marketplace are organized into metal tiers. The tier reflects how costs are split between you and the insurer — not the quality of care. Bronze plans generally have lower premiums and higher out-of-pocket costs; Platinum plans generally have higher premiums and lower out-of-pocket costs.
| Plan tier | Premium | Typical cost when you need care |
|---|---|---|
| Bronze | Lowest | Highest deductible and out-of-pocket costs |
| Silver | Moderate | Moderate costs; extra savings may apply |
| Gold | Higher | Lower deductible and out-of-pocket costs |
| Platinum | Highest | Lowest deductible and out-of-pocket costs |
| Catastrophic | Very low | Limited eligibility; very high deductible |
General comparison only. Plan availability, benefits and cost-sharing vary by state and insurer.
The costs to compare
- Premium: what you pay each month, whether or not you use care.
- Deductible: what you pay for covered services before the plan begins to pay its share.
- Copayment: a fixed amount for a service, such as a doctor visit or prescription.
- Coinsurance: your percentage share of a covered service after the deductible.
- Out-of-pocket maximum: the most you pay for covered care in a plan year before the plan pays 100% of covered benefits.
Add up the annual premium and the care you expect to use. A plan with a higher premium but a lower deductible can be cheaper overall if you see doctors regularly or take expensive prescriptions.
Prescription check: Before enrolling, look up each medication on the plan's drug list (formulary). The same drug can sit on different tiers — and cost very different amounts — from one plan to the next.
Open enrollment and special enrollment
Outside a qualifying event, you generally can't enroll in an individual marketplace plan whenever you like. Open enrollment usually runs in the final months of the year for coverage starting the following January, though state-run marketplaces may set different dates.
A qualifying life event — such as losing employer coverage, getting married, having a baby, moving or turning 26 — can open a special enrollment period. You'll usually need to act within a limited window and provide documentation. Check your state marketplace or Healthcare.gov for the exact rules and deadlines.
Subsidies and savings
Depending on your household income and size, you may qualify for a premium tax credit that lowers your monthly cost, or cost-sharing reductions that lower deductibles and copays on Silver plans. Eligibility rules are complex and can change. Apply through the official marketplace to find out what you qualify for.
Questions to ask before you enroll
- Is my doctor in network, and which hospitals are included?
- Are my prescriptions covered, and what tier are they on?
- What is the deductible, and which services are exempt from it?
- What is the out-of-pocket maximum for an individual and for a family?
- Does the plan cover mental health, maternity care and preventive services?
- Are dental and vision included, or do I need separate cover?
RateFinder is not the Health Insurance Marketplace and does not determine eligibility or issue policies. This information is general and not medical, financial or legal advice. Verify plan details with the insurer or the official marketplace.
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Enroll with confidence
Check the network, prescriptions and effective date before you commit.
Common health plan questions
When can I enroll in a health plan?
You can generally enroll during open enrollment or after a qualifying life event that opens a special enrollment period. Outside those windows, options may be limited. Check your state marketplace for exact dates and eligibility.
What counts as a qualifying life event?
Examples include losing qualifying health coverage, marriage, divorce, having a baby, adopting a child, moving to a new service area, and turning 26 and aging off a parent's plan. Documentation and deadlines usually apply.
What is an out-of-pocket maximum?
It's the most you'll pay for covered in-network care in a plan year. Once you reach it, the plan generally pays 100% of covered benefits. Premiums, out-of-network care and services the plan doesn't cover usually don't count toward the limit.
Are short-term health plans a good alternative?
Short-term plans can be cheaper and easier to obtain, but they typically cover less, can exclude pre-existing conditions and may not count as qualifying coverage. Review the exclusions carefully and consider how they compare with marketplace options before relying on one.
Find a plan you can use
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