Jim OwenTo choose a health insurance plan, compare what each one will cost you over a full year, not just the monthly premium. Add the premium, the deductible and your copays or coinsurance. Then check the out-of-pocket maximum and whether your doctors and drugs are covered. Metal tier and plan type come after that.
Published October 22, 2026.
When is open enrollment for health insurance
On HealthCare.gov, Open Enrollment starts November 1, and from that day you can apply for 2027 coverage. The dates page lists the rest:
- December 15 is the last day to enroll or change plans for coverage that starts January 1. You also have to pay the first premium.
- January 15 is the day Open Enrollment ends.
- February 1 is the start date if you enroll or change plans from December 16 through January 15 and pay the first premium.
After January 15, HealthCare.gov says you can enroll or change plans only if you qualify for a Special Enrollment Period. A life event can open one, such as moving, losing other coverage, getting married or having a baby. Medicaid and CHIP applications can be made at any time.
I have read health news for years. One habit carries straight over to insurance: read the document before the summary. Every fall the ads lead with a low monthly price. That price is only one piece of what a year of care will cost.
Bronze vs silver vs gold health insurance plans
Marketplace plans fall into four metal categories. The difference is how you and the plan split the bill for covered care. HealthCare.gov lists these estimates:
| Category | Plan pays | You pay | Deductible is generally |
|---|---|---|---|
| Bronze | 60% | 40% | High |
| Silver | 70% | 30% | Moderate |
| Silver with extra savings | 73% to 96% | 6% to 27%, depending on the savings you qualify for | Low |
| Gold | 80% | 20% | Low |
| Platinum | 90% | 10% | Low |
The percentages are estimates, and what you actually pay varies by plan. HealthCare.gov says the category names have nothing to do with the quality of care. Every plan in every category must cover the same 10 essential health benefits.
Catastrophic plans are a fifth category, where offered. They are for people under 30 or people who qualify for a hardship or affordability exemption.
HMO vs PPO health insurance plans
The metal category is about cost. The plan type decides which doctors and hospitals you can use. HealthCare.gov describes four types:
| Plan type | What HealthCare.gov says |
|---|---|
| HMO | Usually limits coverage to care from doctors who work for or contract with the HMO. Generally will not cover out-of-network care except in an emergency, and may require you to live or work in its service area. |
| PPO | You pay less if you use providers in the plan’s network. You can use doctors, hospitals and providers outside the network without a referral, for an additional cost. |
| EPO | Covers services only if you use doctors, specialists or hospitals in the plan’s network, except in an emergency. |
| POS | You pay less inside the network, and you need a referral from your primary care doctor to see a specialist. |
Any of these types can appear at any metal level, depending on how many plans are offered where you live. A network is the set of facilities, providers and suppliers the insurer has contracted with. Some plan types restrict your choice of providers. Others pay a greater share of costs for providers outside the network.
How to compare health insurance plans
HealthCare.gov says to compare the estimated total yearly cost of each plan, not just the premium. Here is one way to work through it:
- Add up the yearly cost: the monthly premium times 12, plus the deductible, copayments and coinsurance, up to the out-of-pocket maximum. HealthCare.gov says care costs can add up to more than the premium.
- Pick a level of care. HealthCare.gov’s plan preview lets you choose low, medium or high use. It then estimates a yearly total for each plan. Your actual costs will vary with the services you use.
- Check your doctors, hospitals and drugs. When you view plans, HealthCare.gov says it will tell you whether each one covers them in network.
- Look at savings, covered below under the premium tax credit.
- Read the quality rating. HealthCare.gov gives each rated plan an overall rating from 1 to 5 stars and says plans may differ in quality.
Once each plan has a yearly total, set the numbers next to your other fixed costs. If you want to build a budget around them, the premium is the fixed line. The deductible is the part you may need cash for.
Premium vs deductible
A premium is what you pay every month for coverage, whether or not you use any services, per HealthCare.gov’s glossary. If you are trying to cut monthly costs, it is the obvious line to look at. HealthCare.gov warns that the plan with the lowest monthly premium may not be the best match.
The deductible is what you pay for covered services before the plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 yourself. After that you usually pay a copayment, a fixed amount like $30, or coinsurance, a percentage like 20%.
Many plans pay for some services, like a checkup, before you meet the deductible. HealthCare.gov says all Marketplace plans pay the full cost of certain preventive benefits. Generally, plans with lower premiums have higher deductibles, and plans with higher premiums have lower ones.
What is an out-of-pocket maximum
The out-of-pocket maximum is the most you pay for covered services in a plan year. After you reach it, the plan pays 100% of the cost of covered in-network care. It does not count your premiums, services the plan does not cover, out-of-network care, or charges above the allowed amount.
For Marketplace plans, HealthCare.gov lists the limit as no more than $10,600 for an individual and $21,200 for a family in 2026. For 2027 it is no more than $12,000 and $24,000.
The HealthCare.gov example uses a $1,500 deductible, 20% coinsurance and a $5,000 maximum. On a $125 office visit, the person pays all $125 before the deductible is met. After it, the person pays $25. Once the maximum is reached, the person pays nothing.
What is a high deductible health plan
HealthCare.gov defines a high deductible health plan as one with a higher deductible than a traditional plan, usually with a lower monthly premium. It can be paired with a health savings account. That is why HealthCare.gov says it is more commonly called an HSA-eligible plan.
All Bronze and Catastrophic Marketplace plans work with an HSA, and some plans in other categories do too. HealthCare.gov says HSA funds generally may not be used to pay premiums. Some employers also offer a flexible spending account, and the FSA rules differ from the HSA rules.
How does the premium tax credit work
The premium tax credit lowers your monthly Marketplace premium, per HealthCare.gov. The amount is based on the household information and estimated income on your application, and the credit can be used for a plan in any metal category. You can use all, some or none of it in advance each month.
If you use more than you qualify for based on your final income, you pay the difference when you file your federal taxes. If you use less, the difference counts toward your refund or lowers what you owe. HealthCare.gov says the only way to get the credit is through the Marketplace.
Extra savings on deductibles, copayments and coinsurance are called cost-sharing reductions. HealthCare.gov says you get those savings only if you pick a Silver plan.
Frequently asked questions about choosing a health insurance plan
Can you change a health insurance plan after open enrollment?
Generally only with a Special Enrollment Period, per HealthCare.gov. A life event such as moving, losing other coverage, getting married or having a baby can qualify, and HealthCare.gov lists January 16 through October 31 as the window for using one. Medicaid and CHIP applications can be made at any time.
Is the cheapest health insurance plan the right one?
Not always. HealthCare.gov says the plan with the lowest monthly premium may not be the best match. Someone who needs a lot of care may save money with a slightly higher premium and a lower deductible. Compare the total yearly cost instead.
Do bronze, silver, gold and platinum plans differ in quality?
No. HealthCare.gov says the categories have nothing to do with the quality of care. They only reflect how you and the plan share costs. HealthCare.gov shows plan quality separately, as star ratings from 1 to 5.
What is a surprise medical bill?
The CFPB defines it as an unexpected bill from an out-of-network provider or at an out-of-network facility. The No Surprises Act, effective January 1, 2022, limits surprise bills for emergency services from out-of-network providers. It also limits out-of-network charges for supplemental care, like radiology or anesthesiology, at an in-network facility.
Does the out-of-pocket maximum include the monthly premium?
No. HealthCare.gov says the limit does not count your monthly premiums. It also leaves out services your plan does not cover, out-of-network care and costs above the allowed amount.
This article is for general information only and is not financial advice. Talk to a licensed financial or tax professional about your own situation.
Madeline Marshall
Del Bailey