Health Plan Comparison Worksheet

Use this worksheet to compare individual or employer medical plans on the same assumptions. Print it or copy it into a private document and complete one copy for each plan. It does not calculate a quote, collect information, or rank plans automatically. Guidance was checked November 2, 2026; use documents for the specific coverage year.

1. Define what the comparison must cover

Coverage year and expected covered months: ______.
People to cover and places they receive care: ______.
Essential clinicians, hospitals, and ongoing treatments: ______.
Prescription names, doses, frequency, and pharmacies: ______.
Largest affordable monthly premium and available emergency savings: ______.
Other priorities, such as travel or a planned procedure: ______.

Do not compare a single-person quote with a family quote or a partial year's premium with a full year's cost. Keep sensitive medical details in your own records. Our plan comparison guide explains how to establish priorities.

2. Capture the exact offer

For each candidate, fill in:

Insurer, plan name, identifier, network, and service area: ______.
Plan year and source document date: ______.
Monthly amount you pay after confirmed assistance or employer contribution: ______.
Assistance or contribution already included in that amount: ______.
Required enrollment date and coverage start date: ______.

Obtain the current Summary of Benefits and Coverage and full policy or plan documents. The SBC's sample coverage situations aid comparison but are not personal cost predictions. Check that the summary is for the precise plan variation offered to you.

3. Screen access before calculating costs

Network arrangements differ. Verify the exact plan with the insurer and providers, then record:

Required doctors and hospitals confirmed in network, with check date: ______.
Referral and prior-authorization requirements: ______.
Out-of-network coverage and its separate costs: ______.
Routine care away from home: ______.
Unresolved network questions and responsible contact: ______.

For each medicine, check the formulary and pharmacy rules. Record the tier, deductible treatment, copayment or coinsurance, quantity limits, authorization requirements, and preferred pharmacy. Do not assume the same insurer covers a drug identically in every plan.

Individual and family medical deductible: ______.
Separate prescription deductible, if any: ______.
Services covered before the deductible and their charges: ______.
Primary care, specialist, urgent care, emergency, and hospital cost sharing: ______.
Individual and family in-network out-of-pocket maximum: ______.
Whether individual and family accumulators interact: ______.
Noncovered benefits and expenses excluded from those limits: ______.

Use the cost-sharing terms guide for unfamiliar language. Ordinary income-based Marketplace cost-sharing reductions require an eligible Silver plan; eligible American Indian and Alaska Native applicants have distinct protections. If assistance applies, compare the actual reduced-cost version shown in your eligibility results.

5. Make three spending scenarios

Following HealthCare.gov's total-cost approach, estimate:

Low-use year: premiums for covered months plus likely covered care costs: ______.
Expected-use year: premiums plus your estimated share of planned care and medicines: ______.
High-use year: premiums plus the applicable in-network out-of-pocket maximum: ______.

For each scenario, separately list possible noncovered care, out-of-network expenses, dental or vision costs, and other amounts outside the medical plan's limit. The high-use calculation is not an absolute cap on all spending.

Do not add the full deductible to an out-of-pocket maximum that already includes it. Do not add provider charges in full when the scenario already counts your required copayment or coinsurance. For family coverage, check how one person's spending and the household total count toward the limits.

Record any employer account funding separately and subtract it only once when appropriate. Confirm whether funds are available immediately, gradually, or only through reimbursement.

6. Decide and verify

Plan meeting essential access requirements: ______.
Expected cost advantage and assumptions behind it: ______.
Early-year cash needed before reimbursements or employer deposits: ______.
Remaining uncertainties and answers received: ______.
Reason for final choice: ______.

A cheaper estimate does not override missing access to necessary care. Review the out-of-pocket limit guide before treating any plan as financially predictable.

Finally, save the election confirmation, follow payment instructions, and verify the effective date. Keep these completed worksheets for renewal, but rebuild the comparison with next year's documents rather than carrying forward unverified benefits or prices.