Learning Center . Learning HealthCare.gov . Planning Your Budget

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A Plan For Your Budget

A guide to help you budget your health insurances expenses and determine what you can afford.

See how much of a monthly premium you can afford:

Use the information on this page to create a monthly budget and calculate how much you can spend on your monthly premium. You can change your plan during Open Enrollment (Nov. 1 - Jan. 15) each year.

Thinking about your health needs

To determine the best health plan for you, first ask yourself a few questions to figure out how much care you might need this year:

Do you regularly take prescription medication?
Do you have a disease or illness that requires a specialist, needs regular management, or surgery?
Do you think you will need to see the doctor several times in the next year?
How often do you usually go to the emergency room during a year?

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Check if you qualify for a special plan

Special silver plans (cost-sharing reduction) are Marketplace silver plans with lower out-of-pocket costs. The special silver plan is for lower income.

If you qualify, you’ll pay for a silver plan monthly premium, but get the lower out-of-pocket costs of a gold or platinum plan.

A chart comparing insurance coverage levels and out-of-pocket expenses. Platinum coverage pays 90%, Gold pays 80%, Silver pays 70%, and Bronze pays 60%. Out-of-pocket costs increase as coverage decreases, with platinum having no costs, gold having some, silver more, and bronze the highest.

Check the chart below to see if you may qualify:

    Household Size:
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    Yearly Income Estimate:
    $15,960 - $39,900
    $21,640 - $54,096
    $27,320 - $68,304
    $33,000 - $82,500
    $38,680 - $96,696
    $44,360 - $110,904
  

Find a health insurance network near you

Find a health insurance company network with clinics and a hospital in your area. If you want to keep your current doctor, call their office and ask which insurance companies they work with.

If you need out-of-network care, you may pay higher costs. Out-of-network means the clinic, pharmacy, and labs don’t work with your health insurance company, and you will need approval from your insurance company before you can get care.

Dotted circles with one representing In-Network care, and the other representing Out-of-Network care. In-network dotted circle has healthcare images around it, while Out-of-Network circle does not.

See how much your prescriptions cost

Call the insurance companies in your area to see how much your prescriptions will cost. Some pharmacies have special pricing for common medicines.

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You can download a printable PDF of this information

Click the image to download a copy in English and Spanish.

A chart displaying health insurance plan options, coverage levels, monthly premiums, and out-of-pocket expenses with color coding for different coverage levels and icons representing costs.