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Most people compare health plans by premium because it is the only number on the first screen. A better estimate takes about fifteen minutes and three pieces of paper: last year explanation of benefits, your prescription list, and the summary page of each plan you are considering.
Step one: the fixed cost
Write down twelve months of premiums for each plan, after any premium tax credit you expect. Our guide to how the premium tax credit works explains why that credit depends on your income estimate. This is the amount you pay even if you never see a doctor.
Step two: your predictable care
List the care you are fairly sure about: regular doctor visits, therapy sessions, planned procedures, and monthly prescriptions. For each plan, price that list using its copays where they apply, and its deductible and coinsurance where they do not. Be honest here. Leaving out the specialist you see four times a year produces a tidy estimate and a bad decision.
Step three: the bad year ceiling
Add the premium total to the plan out-of-pocket maximum. That is roughly the worst case for covered in-network care. Some households pick the plan with the lowest expected cost. Others pick the one whose worst case they can survive. Both are reasonable. Knowing both numbers is the point. The method matches the full-year approach in Bronze vs Silver health plans: which costs less in total.
Step four: sanity checks
Confirm your doctors are in network and your medicines are on the formulary. A perfect estimate built on the wrong network is worthless. Then look at whether the plan offers a health savings account option, since the tax treatment can shift a close call; HDHPs and HSAs works through that. Save your worksheet. Next year comparison starts from it, and it takes five minutes instead of fifteen.
