A good Marketplace plan comparison lines up six things for every plan. They are the premium after your tax credit, the deductible, the out-of-pocket max, the network, the drug list and your total yearly cost. Then you test each plan against a light year and a heavy year. The plan with the lowest premium often isn't the one that costs least.
- Your tax credit is based on the second-lowest-cost Silver plan in your area, but you can use it on any metal level.
- For 2027 coverage, the credit stops above 400% of the poverty line, which is $63,840 for one person.
- No ACA plan can make you pay more than $12,000 for one person, or $24,000 for a family, in covered in-network costs for 2027.
- Only Silver plans offer extra savings on deductibles and copays, for incomes up to 250% of the poverty line.
- Total yearly cost means 12 months of premiums plus the care you expect to use.
What to gather before a Marketplace plan comparison
In fact, a side-by-side review goes fast once your facts are ready. Without them, however, every plan looks about the same. So spend ten minutes on this list first.
- Your expected household income for the coverage year
- Every doctor, hospital and pharmacy you want to keep
- Each prescription, with its exact name and dose
- Planned care, such as a surgery, a baby or regular therapy
- Your ZIP code and everyone who needs coverage
Then open a simple spreadsheet or a sheet of paper with one column per plan. That way, your Marketplace plan comparison stays focused on the numbers that matter to you.
The six numbers in a health plan comparison
Every plan page shows dozens of details, so it is easy to get lost. Still, six of them decide most of your cost and access. Here is where to find each one and why it matters.
| Factor | Where to find it | Why it matters |
|---|---|---|
| Premium after credit | Plan results, once you enter income | So you see what you pay monthly |
| Deductible | Plan summary | It's what you pay before most cost sharing starts |
| Out-of-pocket max | Plan summary | Also your worst case for covered in-network care |
| Network | Carrier directory | Then you know which doctors cost the least |
| Drug list | Carrier formulary | Plus the tier sets your price per refill |
| Total yearly cost | Your own math | Finally, it ties all five together |
Each plan also comes with a Summary of Benefits and Coverage, a short, standard document built for side-by-side review. It even includes coverage examples, such as having a baby and managing diabetes. So pull the summary for every plan on your short list.
Step 1: Find the premium after your tax credit
Keep in mind that the sticker price is not your price if you qualify for a credit. Your credit equals the benchmark plan's premium minus what you're expected to pay. The benchmark is the second-lowest-cost Silver plan in your area.
How the credit math works
Say your expected share of the benchmark is $468 a month, and the benchmark costs $690. In that case, your credit is $222 a month. You can then apply that same $222 to a Bronze, Silver or Gold plan. As a result, a cheaper plan can cost you very little, while a richer plan costs the full difference. Because of this, every Marketplace plan comparison should start with after-credit prices.
To run this with your own income, see how premium tax credits are calculated. Then write the after-credit premium at the top of each column.
Steps 2 and 3: Deductible and out-of-pocket max
First, the deductible is what you pay for most care before the plan shares costs. Meanwhile, the out-of-pocket max is your yearly ceiling for covered in-network care. For 2027 coverage, that ceiling can't top $12,000 for one person or $24,000 for a family.
Lower premiums usually mean higher deductibles, so compare the two together. Our guide to the trade-off between deductibles and premiums walks through it. Also read how the yearly spending cap protects you.
Extra savings on Silver plans
If your income is up to 250% of the poverty line, a Silver plan can come with lower deductibles and copays. For one person, that line is $39,900 for 2027 coverage. The bar shows the average share of costs a Silver plan pays at each income level.
So if you qualify, always include at least one Silver plan in your side-by-side review.
A licensed Vivna agent can price plans with your credit, check your doctors and drugs, and show your total yearly cost, at no cost to you.
Steps 4 and 5: Network and drug list
After all, a low price means little if your doctor is out of network. Likewise, a great network won't help if your main drug sits on a high tier. So in any comparison of Marketplace plans, check both before you fall for a premium.
Check the network
For example, HMO and EPO plans generally cover only network care, except in emergencies. PPO plans, by contrast, pay part of out-of-network care at a higher cost. You can compare HMO, PPO, EPO and POS plans or read about HMO and PPO trade-offs. Then search each carrier's doctor directory, and confirm your doctor takes the exact plan.
Check the drug list
Each plan has a formulary, which is its list of covered drugs sorted into price tiers. First, look up every prescription by name and dose. Also note whether a drug needs prior approval before the plan pays.
- Picking a plan by carrier name alone
- Assuming your doctor takes every plan a carrier sells
- Skipping the drug list for a monthly prescription
- Comparing premiums before applying your credit
Step 6: Compare Marketplace plans by total yearly cost
Finally, this step pulls everything together. Total yearly cost means 12 months of premiums plus your likely deductible, copays and coinsurance. HealthCare.gov offers an "Add yearly cost" option that estimates this for low, medium or high use.
Meet Jordan and three sample plans
For example, Jordan is a made-up 45-year-old who expects to earn $55,000 for 2027. That's about 345% of the poverty line, so Jordan's expected share is 10.22% of income, or about $468 a month. The premiums and plan details below are samples for illustration, not quotes.
| Sample plan | After a $222 credit | Deductible | Coinsurance | Out-of-pocket max |
|---|---|---|---|---|
| Bronze | $338 a month | $7,500 | 40% | $10,000 |
| Silver (benchmark) | $468 a month | $5,000 | 20% | $9,000 |
| Gold | $568 a month | $1,500 | 20% | $7,000 |
Jordan's total yearly cost in three kinds of years
Next, we add a year of premiums to the cost of $1,000, $8,000 or $60,000 in network care. For simplicity, all care here counts toward the deductible.
| Sample plan | Premiums | Light year | Medium year | Heavy year |
|---|---|---|---|---|
| Bronze | $4,056 | $5,056 | $11,756 | $14,056 |
| Silver | $5,616 | $6,616 | $11,216 | $14,616 |
| Gold | $6,816 | $7,816 | $9,616 | $13,816 |
What a health plan comparison like this shows
In a light year, Bronze wins by about $2,760 over Gold. However, in a medium year Gold saves Jordan $2,140 over Bronze, and Gold still edges ahead in a heavy year. So the right plan depends on the year Jordan expects, not the premium alone. That is the whole point of a Marketplace plan comparison.
Also, if Jordan's income were under 250% of the poverty line, a Silver plan with extra savings would change the math. To see how the levels differ, read how bronze, silver and gold plans compare.
Comparing plans across carriers
Two Silver plans can share a metal level and still feel very different. So a fair Marketplace plan comparison looks past the logo on the card. For example, carriers build their own networks, drug lists and extra perks. HealthCare.gov also shows quality ratings for many plans, so check them too.
Depending on your state and county, you may see plans from Ambetter Health, Oscar Health or UnitedHealthcare. Availability changes every year, though, so confirm which carriers sell in your ZIP code. Then run each one through the same six steps.
Carriers can leave a market or change networks from one year to the next. So even if you like your plan, compare again at renewal. Otherwise, you may get moved to a different plan, or your doctor may drop out of the network.
Which plan level fits your year
Once your columns are filled in, match the result to how you use care. Here is how our agents usually start the conversation.
A Bronze plan keeps premiums low, while the yearly cap still protects you in a bad year.
Often a Gold plan costs less overall, because cost sharing starts sooner.
Start with Silver, since only Silver comes with extra savings.
Check the network first, then compare price.
Run every plan against two years: your normal year and your worst year. If one plan wins both, then you're done. If not, ask yourself which year would hurt more, and lean toward the plan that protects you there. Also, filter for "easy pricing" plans on HealthCare.gov, since they're simpler to compare.
Compare the year, not just the month.The rule our licensed agents repeat most
Ready to start? Browse ACA and private plans for your ZIP code, or check every enrollment date and deadline explained. You can also call a licensed Vivna agent at 888-730-6001.
Marketplace plan comparison: FAQs
What is the best way to compare Marketplace plans?
Line up six things for each plan: the premium after your credit, the deductible, the out-of-pocket max, the network, the drug list and your total yearly cost. Then test each plan against a light year and a heavy year. Finally, drop any plan that leaves out your doctors or key prescriptions, no matter the price.
Is the plan with the lowest premium the best deal?
Not always. A low premium usually comes with a higher deductible, so a medium or heavy year can cost more in total. For instance, in our sample, the Bronze plan won only in a light year. So add 12 months of premiums to the care you expect, then compare totals.
Does my tax credit work with any metal level?
Yes. The Marketplace bases your credit on the second-lowest-cost Silver plan, but you can apply it to Bronze, Silver, Gold or Platinum plans. However, the extra savings on deductibles and copays apply only to Silver plans. That's why Silver often wins for incomes up to 250% of the poverty line.
When can I switch Marketplace plans?
In most cases, people switch during Open Enrollment. On HealthCare.gov, it runs November 1 to January 15 for 2027 coverage. Also, enroll by December 15 for a January 1 start. After January 15, you generally need a qualifying life event, such as a move or losing other coverage. Some states with their own exchange set different dates.
Should I do a Marketplace plan comparison every year?
Yes. Premiums, networks, drug lists and even carriers can change from one year to the next. Your income and health needs can also shift. So a fresh comparison each fall often turns up a better fit, even if you plan to stay with the same carrier.
Can an agent run a health plan comparison for me?
Yes. A licensed agent can price plans with your credit, check your doctors and drugs, and show your total yearly cost side by side. Vivna's agents compare plans from 50+ carriers at no cost to you. Call 888-730-6001, or browse hundreds of answers to coverage questions.
Vivna's licensed agents compare plans from 50+ carriers. Call Monday through Friday, 9am to 6pm.
Sources
- IRS: Revenue Procedure 2026-26 (2027 applicable percentages)
- CMS: 2027 Premium Adjustment Percentage and Maximum Annual Limitation on Cost Sharing
- HealthCare.gov: Your total costs for health care
- KFF: Impact of cost-sharing reductions on deductibles and out-of-pocket limits
- HealthCare.gov: Summary of Benefits and Coverage
- Dates and deadlines for 2027 health insurance, from HealthCare.gov
Vivna Insurance is a licensed, independent health insurance agency (NPN 19168641). We are not affiliated with HealthCare.gov or any government agency. Plan availability, networks and benefits vary by state and change over time.