Health
Comparing health plans beyond the monthly premium
The premium is the most visible number and frequently the least useful one for comparison.
Four figures together describe what a plan costs: the premium, the deductible, the copayments or coinsurance, and the out-of-pocket maximum. A low premium paired with a high deductible can cost more over a year than the reverse, depending on how much care is used.
The out-of-pocket maximum is the figure that matters in a bad year, because it caps what you pay for covered in-network care. Comparing that ceiling across plans is the single most useful comparison for anyone weighing a serious illness.
Networks decide more than most people expect. Checking that your existing clinicians, your local hospital and any regular medication are covered, before choosing, avoids the most common and most expensive surprise.
Plan documents include a standardised summary of benefits and coverage, written to a common format precisely so that plans can be compared side by side. It is the document to read rather than the marketing page.
What to do next. Compare the out-of-pocket maximums and check your own clinicians and medications against each plan's network before choosing.
studentaid.gov outranks this page. Rules, figures and dates change
between academic years. This is written to help you read the official sources, not to
stand in front of them. Start there.
Nothing here is a determination. We cannot tell you what you qualify
for, and no website can. The programme and the office that runs it decide that, after
you apply.
Still have a question?
Describe what you are trying to work out and a member of the team will answer, or direct you to the office that makes the decision.