It's easy to start shopping with one question: How much is it per month? I get it. That's the bill you see every month. But the monthly price is only one part of what you pay for care.
A plan with a low monthly price can cost you more over a full year. It depends on how the plan shares costs and how much care you use. Here are the five numbers I look at with every person I help.
Number 1: The premium
The premium is what you pay each month to keep your coverage. You pay it even in a month when you don't see a doctor.
Multiply it by 12. That's what the plan costs you in a year before you get any care at all. HealthCare.gov says the plan with the lowest monthly premium may not be the right match for you. If you need a lot of care, a plan with a higher premium and a lower deductible could cost less over the year.
Number 2: The deductible
The deductible is what you pay for covered care before your plan starts to pay. If your deductible is $2,000, you pay the first $2,000 of covered care yourself.
Some care doesn't wait for the deductible. All Marketplace plans pay the full cost of certain preventive care, like shots and screening tests, when you use an in-network provider. Many plans also cover some visits before the deductible. Check your plan details.
Two more things to look for. Some plans have a separate deductible for prescriptions. And family plans often have two: one for each person, and one for the whole family. Our guide to family health insurance mistakes explains how that works.
Number 3: Copays and coinsurance
After you pay the deductible, you still pay part of the cost each time you get care. That part comes in two forms.
- A copay is a set dollar amount, like $20 for a doctor visit.
- Coinsurance is a percentage of the cost, like 20% of a hospital bill.
Look at the copays for the care you use most, like your family doctor, a specialist, or your medicines. In general, plans with lower premiums have higher copays and coinsurance.
Number 4: The out-of-pocket maximum
This is the most you pay for covered, in-network care in a plan year. Your deductible, copays, and coinsurance all count toward it. Once you reach it, the plan pays 100% of covered care for the rest of the year.
As of October 2, 2026, under current law, a Marketplace plan's limit for 2027 can be no more than $12,000 for one person or $24,000 for a family. A plan can set a lower limit.
Know what doesn't count toward it. Your premiums don't. Care the plan doesn't cover doesn't. Out-of-network care doesn't. And neither do charges above the amount the plan allows.
I think of this number as your worst-case year. If someone in your home has a big surgery or a long hospital stay, this is about what you'd pay for covered, in-network care, plus your premiums.
Number 5: Your network and your prescriptions
This isn't one number, but it can change all the others. A plan's network is the doctors, hospitals, and pharmacies it works with.
- An HMO or EPO usually covers only in-network care, except in an emergency.
- A PPO lets you see providers outside the network, but you pay more.
If your doctor isn't in the network, the low numbers you compared may not apply to you. Look up each person's doctors and hospital in the plan's provider directory.
Then check your prescriptions. Every plan has a list of covered drugs, called a formulary. Look up each medicine by name and see what you'd pay for it. When you compare Marketplace plans on HealthCare.gov, you can add your doctors and drugs to see which plans cover them.
Put the five numbers together
This is a made-up example to show how the numbers work. These are not real plans, prices, or clients. Real plans and prices vary by age, area, and income.
Say you're comparing two plans. Plan A costs $350 a month, with a $9,000 deductible and a $10,000 out-of-pocket maximum. Plan B costs $520 a month, with a $2,500 deductible and a $6,000 out-of-pocket maximum. Both cover your doctors and your medicines.
- A quiet year: You only get a checkup. Plan A costs about $4,200 in premiums. Plan B costs about $6,240. Plan A is cheaper.
- A big year: Someone has surgery and you reach the out-of-pocket maximum. Plan A costs $4,200 plus $10,000, or $14,200. Plan B costs $6,240 plus $6,000, or $12,240. Now Plan B is cheaper.
Neither plan is right for everyone. The point is to look at what each plan could cost in a quiet year and in a big year, not just the monthly bill. For a rough first look at pricing, try our Policy Pricing Calculator. If you are weighing metal levels, see bronze vs. silver plans in Florida.
Marketplace plans and private plans use these numbers differently
The five numbers matter on every plan. But the rules behind them depend on the type of plan.
ACA Marketplace plans follow the ACA's rules. Each one has an out-of-pocket limit at or below the yearly federal cap. They must cover health problems you had before you enrolled, and they can't charge you more for them. A tax credit may lower your premium. If your income qualifies for what HealthCare.gov calls "extra savings" (cost-sharing reductions), a Silver plan can have a lower deductible and copays. To check your income first, read how to estimate your income for Marketplace coverage. Florida uses HealthCare.gov. As of October 2, 2026, under current law, open enrollment for 2027 coverage runs November 1, 2026, to January 15, 2027. A court case about these dates is still on appeal, so check HealthCare.gov. See our Florida open enrollment guide.
Medically underwritten private plans, like some private PPOs sold outside HealthCare.gov, work differently. They may not follow all of the ACA's rules, so the federal out-of-pocket cap may not apply. Read the plan's own limit and what counts toward it. Check for limits on certain services and for anything the plan leaves out. Tax credits don't help pay for these plans. Some private plans ask health questions, and approval is not guaranteed. Some may not cover care for health problems you had before you enrolled.
Our page on private PPO vs. Marketplace plans lays out the differences side by side. If you want a PPO network in more than one state, see nationwide private PPO plans.