How to compare health insurance plans online: a step-by-step checklist

Almost everyone shops for a health plan the same way, and almost everyone does it wrong. They sort the list by premium, low to high, pick something near the top, and enroll. Then in March they break an ankle, discover the deductible is $8,000, learn their doctor isn't in the network, and find out the prescription they've taken for years costs full price until that deductible is met. The plan was the cheapest on the screen. It was nowhere near the cheapest plan.

This is the part the comparison sorts on every exchange quietly encourage: the premium is the one number that's big, bold, and identical across plans, so it feels like the thing to compare. It isn't. A premium is what you pay to have the plan. What you'll actually spend is the premium plus everything that happens when you use it — and the gap between those two numbers can run into thousands of dollars. If you've ever wondered which figure should drive the decision, we wrote a whole piece on why the deductible usually matters more than the premium, and the short version is: stop leading with the sticker price.

So here's how to do it properly. This is the checklist we'd walk a friend through, in order, with the reason each step matters and exactly how to do it on HealthCare.gov or your state's exchange. Work it top to bottom and you'll finish with a plan you chose on purpose, not one that chose you.

First, the one idea that changes everything

Every plan has two costs that move in opposite directions. A low premium almost always comes with a high deductible and a high out-of-pocket maximum, and a low deductible almost always comes with a high premium. You're not picking "cheap" or "expensive." You're picking where you want to carry the risk — in predictable monthly payments, or in a big bill if something goes wrong.

That means the only honest way to compare two plans is to look at the best case and the worst case for each:

• Best case (you barely use care): your cost is roughly the premium for twelve months.
• Worst case (something serious happens): your cost is the premium for twelve months plus the out-of-pocket maximum — the cap on what you can be charged for covered, in-network care in a year.

Compare those two ranges side by side and the "cheap" plan often looks very different. A plan that's $90 a month cheaper saves you about $1,080 over a year — but if its out-of-pocket maximum is $4,000 higher, one hospital stay erases that saving three times over. The right question isn't "what's the lowest premium," it's "in a bad year, what's the most this plan can cost me, and can I cover that?"

Hold onto that frame. Everything below is in service of filling in those two numbers accurately for each plan, and then making sure the plan actually covers your doctors and your drugs.

Step 1: Before you look at a single plan, find out what help you qualify for

Why it matters: your subsidy and your cost-sharing eligibility change which plans are even worth looking at — and people who skip this step routinely overpay or pick the wrong metal tier.

There are two separate kinds of help, and they work differently:

• The premium tax credit lowers your monthly premium. It's based on your estimated income for the coverage year and your household size, and it applies to any metal tier you choose.
• Cost-sharing reductions (CSRs) lower your deductible, copays, and out-of-pocket maximum — but only if your income is roughly between 100% and 250% of the federal poverty level, and only if you pick a Silver plan. This is the rule almost nobody knows. According to KFF, a CSR-boosted Silver plan can cut an out-of-pocket maximum from around $10,600 down to a few thousand dollars, at the same premium as a standard Silver, for people who qualify.

So before you sort anything, get your number. Run your household income through a subsidy estimator so you know two things: roughly how much premium help you'll get, and whether you're under that 250% line. If you are, Silver is probably your starting tier, because you'd be leaving free deductible-and-copay help on the table by choosing Bronze or Gold. If you're well above it, the calculus opens back up and Bronze or Gold can make sense.

One honest caveat to date-stamp: under current law as of June 2026, the enhanced premium tax credits that ran from 2021 through 2025 have expired, the 400%-of-poverty subsidy cliff is back, and premiums for many people jumped accordingly. Congress could restore the enhanced credits, but don't plan around a change that hasn't happened. Check your actual subsidy for this year before you assume last year's price.

Step 2: Open the plan list — here's how the screen actually works

On HealthCare.gov, you don't have to apply to look. Use the "see plans and prices" preview to browse with real numbers before you create an account. You enter your zip code, household, and estimated income, and the tool shows the plans available to you with the subsidy already subtracted from each premium.

The feature most people miss is the yearly-cost estimate. On each plan you can choose how much care you expect to use — low, medium, or high — and the exchange adds a projected total for the year that folds in the deductible and expected copays, not just the premium. Set it honestly. If you have a chronic condition or a baby due, you are not a "low" user. This single toggle does most of the total-cost math for you, and it's why previewing on the official site beats eyeballing a broker's premium-only list.

Two more controls worth using before you start reading individual plans: filter by metal tier (set it to Silver first if Step 1 put you under 250% of poverty), and add your doctors and prescriptions up front so the list can flag coverage as you scroll. We'll come back to both of those.

If your state runs its own exchange — California, New York, Colorado, Pennsylvania, and about sixteen others — the site is different but the tools are the same: a plan preview, a yearly-cost estimate, provider and drug lookups, and a link to each plan's full benefit summary. The steps below apply wherever you're shopping.

Step 3: Compare on total annual cost, not the premium

Why it matters: this is the whole game, and it's where the "cheapest" plan and the cheapest plan part ways.

How to do it: for each plan you're seriously considering, write down two numbers. First, the annual premium — the monthly price after subsidy, times twelve. Second, the out-of-pocket maximum — the cap on your in-network costs for the year. Add them. That sum is the worst case: the absolute most that plan can cost you if the year goes badly. Then look at the exchange's yearly-cost estimate for your expected usage level, which sits somewhere between the best case (just the premium) and the worst case.

Now you can rank plans by something real. A Bronze plan with a $40 monthly premium after subsidy ($480 a year) and a $9,200 out-of-pocket max has a worst case near $9,680. A Silver plan at $130 a month ($1,560 a year) with a $6,000 out-of-pocket max has a worst case near $7,560 — over $2,000 less exposure, despite the higher premium. If you can absorb a bad year on the Bronze plan and you rarely see a doctor, Bronze might still be right. If a $9,680 year would wreck you, it isn't, no matter how good that $40 looks.

Step 4: Read the deductible and the out-of-pocket maximum together

Why it matters: these two numbers are not the same thing, and confusing them is one of the most expensive mistakes shoppers make.

The deductible is what you pay for covered services before the plan starts sharing the cost. The out-of-pocket maximum is the hard ceiling — once your spending on covered, in-network care hits it (deductible, copays, and coinsurance all count toward it), the plan pays 100% of covered costs for the rest of the year. The deductible is the start of the plan helping; the out-of-pocket maximum is the end of you paying.

How to do it: look at both for every plan, and read them as a pair. A plan can advertise a low deductible but pair it with high coinsurance and a high out-of-pocket maximum, so you keep paying well past the deductible. Another can have a scary-looking deductible but a relatively low out-of-pocket max, which caps your downside hard. For a year with a major event, the out-of-pocket maximum is the number that protects you, so don't let a low deductible distract you from a high ceiling. One thing that's true on every plan regardless: preventive care — annual physicals, recommended screenings, vaccines — is covered free before you touch the deductible, so don't let a high deductible scare you off routine checkups.

Step 5: Confirm your doctors and hospitals are in the network

Why it matters: a plan that doesn't include your doctor isn't a discount, it's a different doctor. And out-of-network care often doesn't count toward your out-of-pocket maximum at all, which means the cap that's supposed to protect you simply doesn't apply.

How to do it, and do all three:

1. Add your providers during the plan preview. HealthCare.gov lets you enter your doctors so the list flags which plans include them.
2. Search the insurer's own provider directory by name. Click through to the actual carrier's directory and confirm your doctor, your preferred hospital, and any specialist you see regularly.
3. Call the doctor's office. Ask if they take that specific plan for the coming year — not just "that insurer." A practice can be in-network for one of a carrier's plans and out for another, and directories are notoriously out of date. Five minutes on the phone beats a surprise bill.

If a plan you love doesn't include a doctor you can't part with, that's usually the end of the conversation for that plan. Network is where price and reality meet.

Step 6: Check the drug formulary for your prescriptions

Why it matters: a plan's formulary — its list of covered drugs — decides whether your medication is cheap, expensive, or not covered at all. Two plans with identical premiums can treat the same prescription completely differently.

How to do it: enter your prescriptions in the plan preview, then open each plan's formulary and find your exact drugs. Don't just check "covered" — check the tier. Formularies sort drugs into tiers (generic, preferred brand, non-preferred brand, specialty), and the tier sets your cost. Also look for strings attached: prior authorization (the plan must approve it first), step therapy (you must try a cheaper drug before they'll cover yours), and quantity limits. If you take something specialized or expensive, the formulary can matter more than the premium. A plan that puts your drug on a high tier or requires step therapy can cost you more over the year than one with a slightly higher premium that covers it cleanly.

Step 7: Note the plan type and the metal tier

Why it matters: the plan type controls how much freedom you have to see providers and whether you need referrals; the metal tier signals roughly how costs are split between you and the plan.

The plan type is the HMO/PPO/EPO/POS label. In brief: HMOs and EPOs generally cover in-network care only (no out-of-network except emergencies), and HMOs usually require a primary-care referral to see specialists; PPOs cost more but let you go out of network and skip referrals; POS plans sit in between. If you want a specific specialist or travel often, the plan type isn't a detail — it's the whole experience of using the plan. We break down the trade-offs in full in HMO vs PPO vs EPO vs POS, and it's worth five minutes before you commit.

The metal tier — Bronze, Silver, Gold, Platinum — describes the average split of covered costs, not the quality of care. Bronze pays about 60% of covered costs on average and leaves more for you (low premium, high out-of-pocket); Platinum pays about 90% (high premium, low out-of-pocket). The metal tiers are a shorthand for "how much risk am I keeping," and as Step 1 covered, if you qualify for cost-sharing reductions, Silver is the only tier that delivers them.

How to do it: use these as filters, not as the decision. Set the metal tier based on your subsidy situation, set the plan type based on how you want to access care, and then still do the total-cost and network checks above within whatever's left.

Step 8: Watch for a separate prescription deductible

Why it matters: this is the trap door. Some plans run a separate deductible just for prescriptions, on top of the medical deductible. You can meet your medical deductible and still be paying full price for drugs because the drug deductible hasn't been met.

How to do it: in the plan details or the Summary of Benefits and Coverage, look specifically for whether prescription costs have their own deductible or run through the medical one. If you take regular medication, a plan with an integrated deductible (drugs and medical combined) can be meaningfully cheaper in practice than one with a separate drug deductible, even at the same premium. This is exactly the kind of detail the premium-only list will never show you.

Step 9: Read the Summary of Benefits and Coverage

Why it matters: the Summary of Benefits and Coverage (SBC) is the one document built specifically to let you compare plans fairly. Every plan must provide it, in the same format, so you're finally comparing the same things in the same order.

How to do it: on each plan's page you'll find a link to its SBC. Open it and read the top section — deductible, out-of-pocket maximum, whether there's a separate drug deductible, and what you pay for common services. Then scroll to the coverage examples: every SBC shows what the plan would cost in two standardized scenarios — having a baby and managing type 2 diabetes — with the dollars worked out. Because the scenarios are identical across every plan, comparing those two numbers across your finalists is the closest thing to an apples-to-apples cost test that exists. If you read nothing else in full, read the SBCs of your top two or three plans side by side.

Step 10: Check the extras you'll actually use

Why it matters: a plan can be right on cost and network and still miss something you specifically need this year.

How to do it: make a short list of what your household will use, then confirm each plan handles it:

• Telehealth — many plans include low- or no-cost virtual visits, which adds up if you use them.
• Maternity and newborn care — covered on every marketplace plan as an essential health benefit, but the cost-sharing varies; if a baby is coming, run the SBC's childbirth coverage example.
• Mental health and substance-use care — also an essential benefit, but check that your provider is in-network.
• Dental and vision — adult dental and vision are not standard medical benefits; if you need them, you'll usually add a separate plan or look for a medical plan that bundles them.

These won't override a bad total-cost or network result, but between two otherwise-equal plans, the extras you'll genuinely use are a fair tiebreaker.

A worked example, start to finish

Say you're 41, self-employed, and you estimate your income at about 220% of the federal poverty level — which puts you in cost-sharing-reduction territory. You take one ongoing prescription and you'd like to keep your primary-care doctor.

• Step 1 tells you that because you're under 250%, Silver is your tier — CSRs only attach to Silver, so a Bronze plan would throw away free deductible help. You run the subsidy estimator and see your premium help.
• Steps 2–3: you preview plans, filter to Silver, set your usage to "medium," and write down each finalist's annual premium plus out-of-pocket maximum. Three plans cluster close together.
• Step 4: Plan A has a $0 deductible but a higher out-of-pocket max; Plan B has a $1,500 deductible but caps your worst case about $1,800 lower. For a year where something could go wrong, Plan B's lower ceiling wins.
• Step 5: you check the insurer directories and call your doctor's office. Your doctor takes Plan B but not Plan A's network. That settles it further.
• Step 6: your prescription is a Tier 1 generic on Plan B with no step therapy. Good.
• Steps 8–9: Plan B's SBC shows the drug deductible is combined with the medical one, not separate, and the childbirth and diabetes coverage examples come in lower than Plan C's.

Plan A had the lowest premium on the screen. You're enrolling in Plan B, because it's the one whose network has your doctor, whose drug list covers your medication cleanly, and whose worst-case year you can actually afford. That's the whole method.

The mistakes that cost people the most

If you only remember one thing, make it this: the cheapest premium is rarely the cheapest plan. The right plan is the one whose network includes your doctors, whose drug list covers your prescriptions, and whose worst-case year you can afford to live through. Premium is just the price of admission. Compare on everything else, and you'll choose well.

Not sure whether your current coverage is leaving a gap you haven't priced in? Run it through the coverage-gap finder before you renew.