Deductibles, and the question to ask yourself

The cheapest plan on the page is not the cheapest plan for you unless you could actually pay its deductible. That sentence is the whole guide; the rest is how to test it honestly.

The three numbers

The premium is what you pay every month whether or not you use anything.

The deductible is what you pay yourself before the plan starts paying its share for most services. Some services — many preventive ones — are covered before you meet it, which is worth knowing.

The out-of-pocket maximum is the ceiling. Once you reach it, covered in-network care costs you nothing more for the rest of the plan year. This is the number that matters in a bad year, and it is the one people look at least.

We do not print amounts here because they change every year. HealthCare.gov shows the current ones for every plan available where you live.

The test

Look at the plan’s deductible. Then ask, plainly:

If I broke my ankle in February, could I pay that?

Not “would it be uncomfortable”. Could you write the cheque, or put it on a card you could clear, without something else going wrong.

If the answer is no, that plan is not protecting you. It is a lower monthly bill attached to a bill you could not pay, and the usual outcome is that people avoid care they need in order not to trigger it.

If the answer is yes — genuinely yes — a high deductible plan can be a perfectly sensible choice, and the premium saved is real money.

The follow-up question

Ask the same thing about the out-of-pocket maximum, over a whole year.

The maximum is what a serious year costs you. If that number is survivable, the plan is doing the job insurance is for. If it is not, look at a higher tier, where the premium is higher and the ceiling is lower.

Where Silver changes the arithmetic

If your household income falls in a certain range, Silver plans — and only Silver plans — carry cost-sharing reductions, which lower the deductible and the out-of-pocket maximum.

That can turn a Silver plan into the cheapest plan on both counts: lower monthly than Gold, and lower at the point of use than its tier suggests. Choosing Bronze to save a little monthly forfeits it entirely.

Check whether your Silver plans are showing a reduced deductible before you compare anything else. There is a separate guide on it.

What people get wrong

Comparing premiums across tiers without looking at deductibles. The two move in opposite directions by design. A comparison of one column tells you nothing.

Forgetting that some care is covered first. Preventive services are generally covered without meeting the deductible. If your year is mostly check-ups, that changes the calculation.

Assuming the family deductible works like the individual one. On family coverage there are usually both individual and family amounts, and how they interact differs between plans. Read that part specifically if more than one person is on the plan.

Ignoring prescriptions. Some plans apply the deductible to drugs and some do not. If you take medication regularly, that detail can be worth more than the premium difference.

A practical order

1. Work out whether you qualify for cost-sharing reductions. If you do, start with Silver.
2. Check your doctors and your medications by name on the plans you are considering.
3. For each plan still standing, apply the ankle test to the deductible and the year test to the out-of-pocket maximum.
4. Only then compare the premiums.

Most people do that list in reverse and end up with a plan that looked cheap in November.

Where to get help

HealthCare.gov shows all three numbers for every plan available in your county, with your credit applied. The Marketplace Call Center is on 1-800-318-2596, TTY 1-855-889-4325, free, 24 hours. Navigators and certified application counselors help in person and are not paid by insurance companies — localhelp.healthcare.gov.

We will go through the four steps with you at no cost, and we will say plainly when the cheapest plan is not the one to buy.