A low monthly premium does not tell you what health care will cost. To compare plans, understand the recurring premium and the cost-sharing rules that apply when care is used.
Premium
The premium is the amount paid to keep coverage active, usually monthly. It is due whether or not you use care. Premiums generally do not count toward the deductible or out-of-pocket maximum.
Deductible
The deductible is an amount you may pay for covered services before the plan begins paying under certain benefit rules. Not every service necessarily waits for the deductible; some plans apply copays or other benefits first.
Copay
A copay is a fixed amount, such as $40 for an eligible office visit. The amount can differ by service, and the deductible may or may not apply first.
Coinsurance
Coinsurance is a percentage of an allowed cost. If a covered in-network service has a $1,000 allowed amount and the member’s coinsurance is 20% after the deductible, the member portion would be $200 in this simplified example.
Out-of-pocket maximum
This is the most the member pays during a plan year for covered, in-network services that count toward the limit. Premiums, non-covered care, and many out-of-network charges generally do not count. Read the plan’s exact definition.
Network, in-network, and out-of-network
A network is the group of contracted providers and facilities. In-network care usually receives the plan’s negotiated rates and strongest benefits. Out-of-network care may cost more or may not be covered except under defined rules such as emergencies.
Compare a realistic year
Add annual premiums to likely cost sharing for expected visits, prescriptions, labs, and procedures. Then consider a high-use scenario. This reveals more than comparing premiums alone.
Official references: HealthCare.gov total plan costs · HealthCare.gov network definition