Look beyond the monthly premium.
A lower monthly payment can come with higher costs when you use care. Compare the premium alongside the deductible, copays, coinsurance, and out-of-pocket maximum. The right questions depend on the care you expect to need.
Premium
The amount you pay for your health insurance, usually each month. You pay it even in months when you do not use medical services.
Deductible
The amount you pay for covered services before your plan starts paying for certain costs. Some services may be covered before you meet the deductible.
Copay and coinsurance
A copay is a set amount for a covered service. Coinsurance is your share expressed as a percentage. The plan’s rules determine when each applies.
Out-of-pocket maximum
A limit on what you pay for covered, in-network care during the plan year. Premiums and costs for services the plan does not cover generally do not count toward it.
Provider network
The doctors, hospitals, and other providers that contract with a plan. Check the exact plan and provider location before you enroll.
Prescription drug list
Also called a formulary, this lists covered drugs and their coverage rules. Check your medications, costs, pharmacy options, and any approval requirements.
Compare the same details for each plan.
- What would I pay each month and when I use care?
- Are my doctors and preferred hospitals in the network?
- How are my prescriptions covered?
- Are referrals or prior approvals required for care I use?
- When would coverage begin, and what must I do to activate it?
Ask for the plan’s Summary of Benefits and Coverage. Check current insurer documents for the details of a specific plan.
Bring the questions you still have.
You can take your time learning the terms, then start a conversation about your next step. For enrollment timing, see our 2027 Open Enrollment guide.
Call (877) 755-1225