What to compare
Provider network
Confirm your doctors, hospitals and specialists participate in the plan network.
Deductible & cost sharing
Compare what you pay before coverage begins and how copayments or coinsurance apply after the deductible.
Prescription coverage
Review the formulary, drug tiers and pharmacy network for the medications you actually use.
Out-of-pocket maximum
Understand the plan's annual maximum for covered in-network services and what spending does or does not count toward it.
Marketplace and non-Marketplace coverage
Eligibility for premium tax credits and Marketplace savings depends on household and income information and other factors. If you are already eligible for or enrolled in Medicare, Marketplace rules are different—do not assume a Marketplace plan should replace Medicare.
Questions to bring to a review
- Who needs coverage?
- Which doctors and hospitals matter most?
- What prescriptions are taken regularly?
- What monthly premium fits the budget?
- How much financial exposure could you handle in a high-use medical year?