How to Compare Health Insurance Plans: The Three Numbers That Matter

Open enrollment gives you a few weeks to price a year of healthcare, and most people pick the plan with the lowest monthly premium, then discover the deductible in January. The fix is not harder math. It is knowing that a plan comparison comes down to three numbers — premium, deductible, and out-of-pocket maximum — plus one honest estimate of how much care you will actually use.

The metal tiers are a dial, not a rating

Bronze, Silver, Gold, and Platinum describe how costs split between you and the insurer:

Nothing about the tiers says which plan is better. They are price-and-risk dials. The right setting depends on your usage and your cash flow.

The three numbers

1. Premium — what you pay monthly, before and after any subsidy.
2. Deductible — what you pay out of pocket before coverage kicks in.
3. Out-of-pocket maximum — the ceiling on your in-network cost sharing for the year. For 2026 marketplace plans, the cap is around $9,800 for an individual and roughly double for a family (HHS limit). This number is your worst case, and it matters more than the deductible.

The comparison nobody does but everyone should: premium × 12 + out-of-pocket maximum. That is your worst-case year. A Gold plan at $550 a month has a $14,600 worst case (6,600 + 8,000 cap). A Bronze plan at $380 a month has a $14,360 worst case (4,560 + 9,800 cap). The expensive-looking plan can lose its scare factor once you cap the downside.

Subsidies flip the math

Marketplace subsidies cap your premium at a percentage of income, which changes the comparison completely:

• Premium tax credits apply to plans on the marketplace, not off-exchange plans. Compare after subsidy.
• Cost-sharing reductions attach only to Silver plans for households below roughly 250% of the federal poverty level, lowering deductibles and copays. A subsidized Silver plan can beat a Bronze plan at almost every spending level.
• If your income changed this year, re-enter it — the subsidy is recalculated annually, and over- or under-reporting creates a reconciliation at tax time.

This is why the "lowest premium wins" habit is wrong twice: once for the unsubsidized worst-case math, and again when subsidies and Silver cost-sharing are on the table.

The comparison walkthrough

Run the health insurance plan comparison calculator with your real plan numbers — premium, deductible, out-of-pocket max, and copay levels. It shows total annual cost across spending scenarios, so you can see where each plan wins:

• Low usage (one or two visits): the low-premium plan usually wins.
• Moderate usage (chronic medication, therapy, a procedure): the crossover appears fast.
• High usage (surgery, pregnancy, ongoing treatment): the low-out-of-pocket plan wins, and the worst-case number decides it.

Then check the two things no calculator can: network (is your doctor and the nearest hospital in it?) and formulary (are your prescriptions on it?).

What to do this enrollment

1. Pull this year's actual spending — claims, prescriptions, visits.
2. Estimate next year's care needs honestly, including anything scheduled.
3. Enter your income in the marketplace tool first; subsidies change everything.
4. Compare worst-case totals, not premiums.
5. Check network and drug lists before enrolling.

The same worst-case discipline applies to your other policies. The insurance calculators apply it to auto deductibles, coverage gaps, and claim costs, and the income protection guide covers the coverage most people skip entirely — the policy that pays when you cannot work.

Bottom line

Health plan comparison is three numbers plus one honest usage estimate, and subsidies change both. Price your worst case, check the network, and run the plan comparison calculator before you click enroll.