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Your medical needs determine which plan type saves you the most money. If you visit specialists regularly or take expensive medications, paying higher monthly premiums for better coverage costs less than choosing a bare-bones plan with very high deductibles. If you rarely see doctors beyond annual checkups, a high-deductible plan with lower premiums is likely your best option.

Calculate your annual health care spending (doctor visits, prescriptions and planned procedures), plus a buffer for unexpected costs. Then compare that total against each plan's premium plus estimated out-of-pocket costs.

Not all plans cover the same doctors and hospitals. Before comparing costs, confirm that your preferred providers are in-network. Out-of-network care costs 40% to 60% more, even with insurance.

• HMO plans have lower premiums and smaller networks. You’ll need referrals to see specialists, and out-of-network care isn't covered except in emergencies.
• PPO plans have higher premiums but offer more flexibility. You can see specialists without referrals, and some out-of-network care is covered.
• EPO plans cost less than PPOs. You can see specialists without referrals, but out-of-network care isn't covered except in emergencies.
• POS plans combine features of HMOs and PPOs. You’ll need referrals to see specialists, but you can receive out-of-network care at a higher cost.

Before comparing metal levels and monthly premiums, check whether you qualify for a premium tax credit. For 2026, a single adult earning up to $63,840 or a family of four earning up to $132,000 may qualify, depending on other eligibility requirements.

Your savings affect which metal level offers the best value for you. Households earning up to 250% of the federal poverty level may also qualify for cost-sharing reductions, which are available only with Silver plans. Enter your income information on HealthCare.gov to compare plans using your estimated costs after financial assistance.

Health plans use metal tiers (Bronze, Silver, Gold and Platinum) to show how costs split between you and your insurer. Bronze plans have the lowest premiums but the highest deductibles. Platinum is the opposite: you pay more each month but less when you use care.

• Bronze plans are the right fit for healthy people with savings to cover unexpected costs. After meeting your deductible, you pay 40% of medical bills.
• Silver plans fall between Bronze and Gold on monthly cost and coverage. You pay 30% of costs after your deductible, and Silver plans qualify for cost-sharing reductions if your income falls below certain thresholds.
• Gold and Platinum plans pay off if you have chronic conditions, take multiple medications or expect major medical expenses. With Gold, you pay 20% after your deductible. Platinum drops that to 10%.

These five cost terms determine what you actually pay under any plan:

• Premium: Your monthly payment, whether you use health care or not. Lower premiums mean higher costs when you need care.
• Deductible: What you pay before insurance takes effect. A $3,000 deductible means you cover the first $3,000 of medical costs each year.
• Co-insurance: Your share after meeting the deductible. With 20% co-insurance, you pay $20 of every $100 bill, and insurance covers $80.
• Copay: A fixed amount for specific services. You may pay $25 per doctor visit or $10 per prescription, regardless of the actual cost.
• Out-of-pocket maximum: Your annual cost ceiling. Once you reach this limit (up to $9,200 for individual coverage in 2026), insurance covers 100% of additional costs for the year.

Check each plan's formulary (drug list) to see whether your medications are covered and what tier they fall under. Tier 1 drugs have the lowest cost. Tier 4 and specialty drugs can run hundreds or thousands of dollars a month, and some plans won't cover them without prior authorization.

For anyone on expensive medications, a plan with better drug coverage can cost less than a cheaper plan that excludes or restricts your medications.