A low monthly premium can leave you with higher costs when you need care. Compare what you will pay for coverage, the care you expect to use, and the protection each plan offers in a costly year.
Start with your enrollment deadline
For HealthCare.gov, open enrollment for 2027 coverage runs from November 1, 2026, through January 15, 2027. Select a plan by December 15 for a January 1 start. Selections from December 16 through January 15 generally start February 1. Pay your first premium to complete coverage. See the federal enrollment manual.
These dates apply to the federal Marketplace. If your state runs its own Marketplace, check its dates and coverage start rules. Outside open enrollment, certain life changes may qualify you for a special enrollment period.
Know the costs you are comparing
The premium is your monthly payment for coverage, even if you get no care. Multiply your share after any applicable premium tax credit by 12 for a full-year comparison. Your actual premium can change if your household or income changes.
A deductible is the amount you pay for certain covered services before the plan begins paying its share. A copayment is a fixed charge, while coinsurance is a percentage of an allowed charge. Check which services are subject to the deductible.
| Cost | What to check |
|---|---|
| Premium | Monthly amount after any applicable savings, multiplied by 12. |
| Deductible | The amount and which services or prescriptions it applies to. |
| Copay or coinsurance | Your share for visits, medicines, tests, and hospital care. |
| Out-of-pocket maximum | The annual limit for covered in-network care, separate from premiums. |
The out-of-pocket maximum includes deductible payments, copayments, and coinsurance for covered in-network care. It does not include premiums, uncovered services, or out-of-network costs. Check the plan terms for exceptions and details. See the HealthCare.gov definition.
Compare two possible years
These fictional plans cover one person for all 12 months. The amounts below assume the stated care is covered and in network. The care amounts already include deductibles, copays, and coinsurance, so do not add the deductible again.
| Cost | Plan A | Plan B |
|---|---|---|
| Monthly premium | $250 | $400 |
| Annual premiums | $3,000 | $4,800 |
| Expected care payments | $2,400 | $600 |
| Estimated total | $5,400 | $5,400 |
| In-network maximum | $8,000 | $4,000 |
The plans tie at $5,400 under this particular care scenario. In a year when covered in-network spending reaches each maximum, premiums plus that maximum would be $11,000 for Plan A and $8,800 for Plan B. That comparison excludes uncovered and out-of-network costs.
The example does not predict your bills. Repeat it with your own expected visits, prescriptions, and procedures. Also check whether you can afford the monthly premium and a large bill early in the year.
Check doctors, hospitals, and prescriptions
A provider network is the group of doctors, hospitals, pharmacies, and other providers that contract with a plan. Plan types differ in their coverage of out-of-network care and referral requirements. Compare network types.
Check the exact plan name and year in the insurer’s directory. Then confirm with each important provider and facility that they expect to participate in that plan in 2027. Ask whether a specialist requires a referral and whether a planned procedure needs prior authorization.
A plan may cover a medicine but charge different amounts depending on its tier or pharmacy. Directories and drug lists can change, so keep a record of the information you confirm.
Check savings before comparing premiums
The Marketplace application uses your household and estimated income to determine whether you qualify for a premium tax credit. Preview prices are estimates. The application asks for more information and gives you plan prices based on your eligibility. Learn how plan estimates work.
Some applicants also qualify for cost-sharing reductions, which lower deductibles, copays, coinsurance, and the out-of-pocket maximum. For the income-based reduction, you must choose a Silver plan. Compare the actual Silver terms shown after you apply. See the cost-sharing rules.
Estimate your income for the coverage year carefully and update the Marketplace if it changes. Advance tax credits are reconciled on your federal tax return, so the amount you ultimately qualify for can differ from the advance payments.
Make the comparison fit your budget
Estimate a normal year
List the care and prescriptions you reasonably expect. Use each plan’s terms to estimate your share, then add annual premiums.
Test a costly year
Add 12 months of premiums to the in-network out-of-pocket maximum. Keep uncovered and out-of-network costs separate.
Check the cash flow
Consider the monthly premium and how you would pay the deductible or a substantial bill before the maximum is reached.
Confirm and enroll
Check providers, medicines, savings, plan documents, and your deadline. Pay the first premium and retain your confirmation.
The lowest estimated annual total is useful, but it is not the only decision. A plan with a higher premium may offer a lower ceiling for covered in-network care. A different plan may fit your budget better if you can manage its higher costs when you need care.
Sources and update
Checked November 2, 2026. The example uses fictional amounts. Benefits, prices, eligibility, and provider networks depend on your circumstances and plan.
Frequently asked questions
Is the deductible the most I can pay?
No. Covered in-network copayments and coinsurance can continue after you meet the deductible, until you reach the plan’s out-of-pocket maximum. Premiums and certain other costs are separate.
Does a low premium mean the lowest total cost?
Not necessarily. Add the annual premiums to your estimated payments for covered care. Compare the out-of-pocket maximum and check whether your doctors and medicines are covered.
Can I enroll after January 15?
You may qualify for a special enrollment period after certain life changes, such as a qualifying loss of coverage. The rules depend on the event. Medicaid and CHIP enrollment have different timing rules.
Do I have to choose a Silver plan for a premium tax credit?
No. A premium tax credit can apply to other eligible plan categories. Income-based cost-sharing reductions require a Silver plan.