Guides / Compare yearly cost
Which setup fits your situation.
Fixed indemnity, a private major medical PPO, and the Marketplace each do a different job. Use the notes below to see which one matches how you want coverage to work, then add your own numbers.
Which health plan fits your situation?
Fixed indemnity, a private major medical PPO, and the Marketplace each do a different job. Match the setup to how you want coverage to work.
Cash benefits
- Predictable cash benefits for covered services, with the dollar amount in the brochure.
- Lower cost, so the monthly premium is easier to plan around.
- Flexibility in how you use the benefit on the bill for that service. Fixed indemnity plans.
Major medical
- Full major medical that shares the cost of covered care.
- A PPO network of doctors and hospitals.
- Underwritten pricing. The premium reflects your health. A healthy applicant may pay less than on the Marketplace. That is not a promise. Private major medical PPO plans.
The Marketplace is the option that accepts you without health questions. Income can change that premium. We can help with an ACA plan too.
How do you compare a year of cost?
Use your own numbers. The addition shows a year of premium plus one more figure. It does not choose for you.
Plan with an out-of-pocket maximum
Use this side for a Marketplace plan or a private major medical PPO. Both state a maximum you pay in a year for covered in-network care.
If the plan has a deductible, do not add it on top of the maximum. On a typical ACA plan the maximum already includes the deductible. Confirm that on the plan summary.
Premium for the year: $0
Premium for the year, plus that maximum: $0
Fixed indemnity plan
Type the monthly premium and a bill you want to look at next to a year of that premium. The cash benefit is the set amount in the brochure. This box is one way to see a year of cost.
A hospital stay or a surgery is the kind of bill people type here, next to the cash benefit the brochure lists for that care.
Premium for the year: $0
Premium for the year, plus that scenario: $0
Read the totals as arithmetic. Networks and the care each plan is built for sit outside the math. If a quote lists a monthly membership fee, include it in the monthly premium you type. If it lists a one-time application fee, remember it is not in the monthly math.
What else should you check?
Check Marketplace savings, the doctors you want to keep, and which private option matches the job you want the plan to do.
- Marketplace savings follow the income you estimate. If you earn more than that estimate, you may have to pay some of the savings back when you file taxes. HealthCare.gov explains the rules. Put the premium after any savings estimate into the worksheet, and tell Seth you did that.
- Write down the doctors you want to keep. Check each plan's provider search before you rely on a name. Provider search
- Fixed indemnity fits when you want cash benefits, a lower premium, and flexibility. Fixed indemnity plans.
- A private PPO fits when you want full major medical, a network, and underwritten pricing. A healthy applicant may pay less than on the Marketplace. That is not a promise. Private major medical PPO plans.
When the Marketplace fits
- You need maternity, mental health, substance use treatment, or pediatric dental covered.
- You need a plan that accepts you without health questions.
- You want to check income-based savings on HealthCare.gov.
- You are on Medicare, or you are getting close to it. We can help with that too.
Need an ACA plan? We can help with that too. HealthCare.gov or 1-800-318-2596.
Questions about your own coverage go to Seth. This page cannot answer them.