Use these worksheets to compare costs:
Compare HMO Costs
Compare PPO Costs
Many people buy the cheapest plan. A less expensive plan can provide good basic benefits and high quality care. However, make sure you know all the costs of a plan. And make sure it covers the benefits you need most. A low premium won't save you money if the care you need is not covered.
Topics on this page
- Ask for a summary for each plan you are thinking about. Your employer's benefits office or the health plan can usually give you this summary.
- Make a list of the ones you think you can afford.
- Use the worksheets to compare HMO costs and PPO costs.
If you buy insurance on your own, you can compare costs online through Covered California, a health insurance marketplace. Visit www.coveredca.com to preview plans and compare costs.
You can also look into what plans cost outside of Covered California by contacting the insurance company directly, working with an insurance agent, or by using an insurance broker website. Be aware that outside of Covered California you will not qualify for tax credits to help pay premiums.
- High deductible plans: The deductible is at least $1,050 for an individual and $2,100 for a family, and it can be much higher. You have to pay the full deductible before the plan starts to pay for services. These plans work best if you are not likely to need health care or if you are able to pay out-of-pocket when you need health care. Learn more about high deductible plans.
- Co-insurance instead of co-pays: Co-pays are flat fees, like $15 for an office visit. Co-insurance is a percent of the cost of the service. If you have to pay 25% of all your health care costs, you can spend a lot of money out of pocket.
- Network of providers: Health plans have networks of doctors and other providers. It will likely cost you more if you go to an out-of-network provider (if it isn't an emergency). Check that a doctor, hospital, or medical group you want to go to is in the plan network.
- Hospital fees. Check the costs. The co-pay or co-insurance can be high.
- Special deductibles, like a deductible for prescription drugs.
- Special limits on what the plan will pay, like a limit on services not considered as part of the essential health benefits.
- The yearly out-of-pocket maximum: If you meet this, you do not need to worry about co-insurance or hospital costs for the rest of the year.