Why a Worksheet Beats Guessing

Most people start shopping for health insurance by comparing monthly prices. That's backwards. The plan with the lowest premium isn't automatically the best deal, and the "best" plan for your neighbor might be a poor fit for you. This worksheet walks you through the same questions an experienced buyer asks themselves before ever requesting a quote, so you can compare plans on what actually matters to your situation instead of price alone.

It's also a good time to do this yourself. Federal funding for Navigator programs, the nonprofit counselors who help people enroll in person, was cut by roughly 90% for 2026, so free one-on-one help is much harder to find this year than in past years. A clear worksheet you can work through on your own is more useful now than ever.

Step 1: Figure Out Where You're Starting From

Your starting point determines which rules apply to you. Check the situation that fits best:

  • You have employer coverage and are just evaluating whether it's still your best option.
  • You're uninsured right now and need to find coverage.
  • You're losing coverage soon, from a job change, aging off a parent's plan at 26, or a Medicaid redetermination.
  • You're self-employed or run a small business and are shopping for yourself, your family, or your team.
  • You're approaching 65 and need to understand how Medicare fits in.

Keep your answer in mind. Step 6 links you to a deeper guide for each of these.

Step 2: Know Your Enrollment Window

This matters more than almost anything else on this page. ACA Marketplace plans aren't available for purchase year-round. The next general Open Enrollment Period runs November 1 through December 15, 2026, for coverage starting January 1, 2027.

If you're reading this outside that window, you generally need a Special Enrollment Period, triggered by a qualifying life event, to enroll before then. Common qualifying events include losing other coverage (including losing Medicaid), moving to a new area, getting married, having or adopting a child, or a change in household income that affects your eligibility. Most Special Enrollment Periods give you 60 days from the event to enroll, so don't sit on it if one applies to you.

Step 3: What Changed for 2026 (Don't Skip This)

If you last shopped for coverage before 2026, a few things are genuinely different now:

  • Subsidies got smaller for a lot of people. The enhanced premium tax credits that had lowered Marketplace premiums since 2021 were not renewed by Congress and expired at the end of 2025. Help is still available if you qualify, but for many enrollees it's less generous than it was last year, and the old income cutoff for eligibility (400% of the federal poverty level) is back in effect. Independent research groups tracking this found the typical subsidized enrollee's premium payment roughly doubled year over year. Your actual number depends on your income, household size, and state, so run your own numbers on HealthCare.gov or your state's marketplace rather than assuming last year's quote still applies.
  • Medicaid work requirements are new in many states. Adults on expansion Medicaid are now generally required to document around 80 hours a month of work, school, or another qualifying activity to stay enrolled. If this applies to you and you lose Medicaid as a result, that loss of coverage is itself a qualifying life event, which opens a Special Enrollment Period for Marketplace coverage.
  • Average premiums rose sharply industry-wide heading into 2026, on top of the subsidy changes above. It's a good year to actually compare plans rather than auto-renewing whatever you had.

Step 4: Your Priorities Checklist

Go through this list and note which ones matter to you. This is what actually separates a good plan from a bad one, far more than the sticker price:

  • Do you want to keep seeing your current doctors? If yes, checking their network status matters more than comparing premiums.
  • Do you take regular prescriptions? Look at each plan's drug formulary and pharmacy copay tiers, not just the medical benefits.
  • Are you expecting a procedure, pregnancy, or ongoing treatment this year? A higher premium with a lower out-of-pocket maximum usually wins in this case.
  • Do you rarely use care beyond an annual checkup? A lower premium with a higher deductible may genuinely save you money.
  • Do you travel often or split time between states? Some plan types (like HMOs) restrict coverage outside your home network area more than others.
  • Are you weighing an employer plan against a Marketplace plan? Compare the total picture, premium, deductible, and out-of-pocket maximum, on both, not premium alone.

Not sure what these terms mean yet? Health Insurance Basics covers premiums, deductibles, copays, and out-of-pocket maximums in plain language, and HMO vs. PPO breaks down how plan types differ on network flexibility.

Step 5: Estimate Your Real Yearly Cost

Add up your annual premium (monthly cost times 12) plus what you're realistically likely to spend on deductibles, copays, and coinsurance based on how much care you used last year. That total, not the monthly premium by itself, is the number that actually tells you what a plan will cost you. The Health Insurance Basics guide walks through this calculation in more detail if you want a refresher.

Step 6: Match Your Situation to the Right Guide

Based on your answer in Step 1, one of these will apply directly to you:

Step 7: You're Ready. Go Get Quotes.

Once you've worked through the steps above, you know your enrollment window, your priorities, and roughly what you can afford. That's exactly the information a quote conversation should start with. Head to our Health Insurance Quote Checklist for what to have ready before you request quotes, or use the form on our homepage to get matched with licensed providers directly.