Reviewed by Tina Price, licensed health insurance advisor, on October 30, 2026.

How to compare plans: doctors, drugs and the real yearly cost

The cheapest premium is rarely the cheapest year, so check your doctors, your medicines, and the deductible and out-of-pocket maximum before you choose.

Last updated October 30, 2026

The short version

Check that your doctors are in the plan's network before anything else.
Check that each medicine is on the plan's drug list, called a formulary.
Estimate a bad-year cost: premiums plus the out-of-pocket maximum.
Compare every plan with the same household and county, so the prices line up.

Step 1: list your doctors and medicines

Write down every doctor, clinic, and hospital you use, and every medicine with its dose. Everything else depends on this list.

Step 2: check the network

A network is the doctors, hospitals, and suppliers a plan has agreements with. Care outside the network can cost much more, and may not count toward your deductible.

Do not rely on a doctor's front desk saying they take your insurance. Check the plan's own directory, and ask the office whether they are in network for the specific plan.

HMO plans generally require a primary care doctor and referrals to see specialists. EPO plans generally do not. HMO networks are usually smaller.

Step 3: check the drug list

A formulary is the list of prescription drugs a plan covers. Look up each of your medicines. Note the tier and any rules, such as needing approval first.

If a medicine you take is not covered, ask your doctor about alternatives before you choose.

Step 4: understand the cost pieces

The deductible is what you pay for covered care before the insurance starts paying. After that, you usually pay a copay (a flat fee per visit) or coinsurance (a percent of the bill).

The out-of-pocket maximum is the most you pay for covered, in-network care in a year. Premiums do not count toward it.

Step 5: estimate the real yearly cost

For each plan, work out two numbers. A good year is the premiums for twelve months plus your routine care. A bad year is the premiums plus the out-of-pocket maximum.

An example with made-up numbers. Plan A costs $400 a month with a $9,000 out-of-pocket maximum, so a bad year is $4,800 + $9,000 = $13,800. Plan B costs $550 a month with a $5,000 maximum, so a bad year is $6,600 + $5,000 = $11,600. Plan A is cheaper every month, and Plan B is cheaper in a bad year.

Then ask which you could live with. A low premium with a high maximum is a risk only if you couldn't pay that maximum.

Step 6: look at financial help

If you qualify for the tax credit, the price you see already reflects it. If your income is up to 250% of the federal poverty level, look at enhanced silver plans. They can lower your deductible and copays.

Recheck the plan each year. Plans change their networks, drug lists, and prices every year, and a renewal is not a recommendation.

Next step

Have your doctor and medicine list ready. Our comparison checks your medicines against each plan's drug list and links to each network's doctor directory. It can also sort by the most you would pay in a year.

Want a person to check your pick? A licensed Grove advisor will, at no cost.

Compare plans Call (970) 840-1130

Common questions

How do I make sure my doctor is in network?

Check the plan's provider directory, then call the doctor's office and ask if they are in network for that specific plan name. Directories can be out of date.

Does the out-of-pocket maximum include my premiums?

No. It does not include premiums, care the plan does not cover, or out-of-network care.

Is the plan with the lowest premium a bad choice?

Not always. It can be right if you rarely use care and could cover the deductible. Compare the full yearly cost first.

Sources

This guide is general information, not tax or legal advice. Connect for Health Colorado decides eligibility and tax credits.

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