Open Enrollment: Compare Health Plans by Total Yearly Cost, Not Premium

• 1. Annual premium
• 2. Three scenarios, not one
• 3. Deductible vs. out-of-pocket maximum
• 4. HSA eligibility
• 5. Doctors and prescriptions
• Free tools

Open enrollment season is when many people pick next year’s health plan. Comparing plans by premium alone often picks the wrong one. A better comparison looks at the total yearly cost under a few scenarios.

§1. Annual premium

Monthly premium (your share) times 12. This is the cost you pay even if you never see a doctor.

§2. Three scenarios, not one

For each plan, estimate the total for:

• A quiet year: premium plus a few routine visits and prescriptions.
• A typical year: premium plus your usual visits, prescriptions and one or two unexpected costs.
• A bad year: premium plus the out-of-pocket maximum.

The bad-year number is the worst case you need to be able to absorb.

§3. Deductible vs. out-of-pocket maximum

The deductible is what you pay before most coverage starts. The out-of-pocket maximum caps your spending for covered in-network care in a year. Two plans with the same deductible can have very different maximums.

§4. HSA eligibility

If a high-deductible plan is HSA-eligible, money you put in the HSA is generally tax-advantaged. Count any employer HSA contribution as a reduction of that plan’s cost.

§5. Doctors and prescriptions

Check that your doctors are in network and look up your regular prescriptions in each plan’s formulary. A cheap plan that drops a key medication can end up expensive.

§Free tools

• Health insurance plan comparison spreadsheet (free CSV for Excel / Google Sheets): https://smartbudgetsheets.surge.sh/templates/health-insurance-plan-comparison-spreadsheet/?utm_source=nostr
• HSA medical expense tracker: https://smartbudgetsheets.surge.sh/templates/hsa-medical-expense-tracker-spreadsheet/?utm_source=nostr

General information, not financial or insurance advice. Plan rules vary; check each plan’s documents.