The first step is to assess your needs, including your age, health status, current medications, as well as those of any other family members who will be covered by the plan. Corlette says you also need to know your risk tolerance.
“Some people feel very comfortable paying as low of a premium as possible,” she says. “But they may get hit with a high deductible. Other people will want to pay more each month knowing if they do get sick, they won’t be hit with a massive bill.”
Once you’ve narrowed down the list of options, it’s time to dig into the details about what each of the plans will cost.
“When you’re shopping for health insurance, there are two kinds of costs,” says Young. “One is the monthly premium, and the other is cost sharing, such as deductibles and copays. It’s generally true that plans with lower premiums have higher cost sharing. Healthier people who don’t use a lot of medical services will find they’re better off with lower-premium plans that aren’t as generous, and people who have more medical expenses will want a low deductible health plan.”
For all regulated health insurance plans, there is an out-of-pocket annual maximum — meaning, the most you’ll be responsible for paying before your health insurance covers the cost of the bills. In 2025, that amount is $9,200 for an individual and $18,400 for a family.
“Even if you’re paying the lowest premium, there will still be a cap,” she says. “At the end of the day, you’re protected, so the decision of which plan to choose has less consequence than maybe it used to.”
There is, however, a big asterisk here: The out-of-pocket maximum usually only counts toward in-network care, says Corlette, so if you go out of network, you may have to foot the entire cost of that bill.
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