Health insurance, without the jargon.

Health plans are hard to compare because the monthly premium is only one piece of what you will pay. The plan that is cheapest each month can be the most expensive over a year if you need regular care, and a low-deductible plan is wasted money if you rarely see a doctor.

The cost terms that matter

• Premium: what you pay every month to keep the plan, whether or not you use it.
• Deductible: what you pay for covered services before the plan starts sharing costs. Many preventive services are covered before the deductible.
• Copay and coinsurance: your share after the deductible, either a flat amount (copay) or a percentage (coinsurance).
• Out-of-pocket maximum: the most you pay for covered in-network care in a plan year. After that, the plan pays 100% of covered in-network costs.

Networks

HMOs usually require you to stay in network and get referrals; PPOs allow out-of-network care at a higher cost; EPOs fall in between. Before choosing, check that your doctors, preferred hospital and prescriptions are covered, and look at the plan’s drug formulary.

Where coverage comes from

Most people get coverage through an employer, the ACA Marketplace (HealthCare.gov or a state exchange), Medicaid or Medicare. Marketplace plans are grouped into Bronze, Silver, Gold and Platinum tiers that reflect how costs are shared, and income-based premium tax credits can lower the price. Open Enrollment for Marketplace plans generally runs from November 1 to January 15 in most states; outside that window, a qualifying life event such as losing other coverage, moving, marriage or a new child can open a Special Enrollment Period, usually lasting 60 days.

A simple way to compare

Estimate a realistic year of care, then add twelve months of premium to the deductible and cost sharing you would likely pay, and compare that total against each plan’s out-of-pocket maximum as a worst case. The guides below explain each step. Turning 65? See our Medicare guides.