How to compare health insurance plans — without guessing.

Step 1: Compare total yearly cost, not premium

The premium is the only number insurers put in big type, which is exactly why it misleads. What you actually spend in a year is:

Total cost = (monthly premium × 12) + what you pay when you use care

Run the number twice for each plan: once for a typical year (a few doctor visits, your regular prescriptions) and once for a bad year (you hit the out-of-pocket maximum). A plan with a $480 premium and a $9,000 out-of-pocket max can cost more in a bad year than a plan with a $610 premium and a $4,500 max. If a bad year would be financially painful, the second plan is cheaper where it counts.

Step 2: Check the network

Before anything else, list the doctors, hospitals, and specialists you actually use — then verify each one is in-network on the carrier's own directory, not a third-party site. Networks for the same carrier can differ between marketplace and off-marketplace versions of a plan, so check the exact plan name.

If you travel often or split time between states, pay attention to whether the plan offers any out-of-network coverage at all. HMO and EPO plans generally cover none outside emergencies; PPO plans cover some, at a higher cost share.

Step 3: Check your prescriptions

Every plan has a formulary — the list of drugs it covers and at what tier. Two plans with identical premiums can differ by hundreds of dollars a month on the same medication. Look up each prescription you take, note the tier and any prior-authorization requirement, and add the annual cost to your comparison from Step 1.

Step 4: Match the plan type to how you use care

Step 5: Read the fine print that matters

Five lines in the summary of benefits change the real value of a plan more than anything else:

• Deductible — what you pay before the plan starts sharing costs.
• Out-of-pocket maximum — the absolute most you'll pay in a year. This is your financial ceiling.
• Coinsurance vs. copay — 20% of a $3,000 MRI is very different from a $75 copay.
• Prior authorization — services that need approval first, and how strict the plan is about it.
• Separate deductibles — some plans have a second deductible for prescriptions or out-of-network care.

A simple comparison worksheet

For each plan on your shortlist, write down six numbers: monthly premium, deductible, out-of-pocket max, your prescriptions' annual cost, whether your doctors are in-network (yes/no), and the plan type. The right choice usually becomes obvious once they're side by side — and if it doesn't, that's the moment a licensed advisor earns their keep. We do this comparison for you, for free.