Choosing a health insurance plan comes down to four things: how often your family uses care, which doctors and medications you need covered, how much you can afford each month, and how much risk you're comfortable taking on if something goes wrong.
Start with the plan tier. ACA plans are organized into four metal levels based on how costs are split between you and the insurance company:
- Bronze: Lowest monthly premium, highest out-of-pocket costs when you use care. Good for healthy people who rarely need medical services.
- Silver: Mid-range premiums and cost-sharing. The only tier eligible for Cost-Sharing Reductions if your income qualifies. Often the best value for families.
- Gold: Higher monthly premium, lower out-of-pocket costs. A strong choice if someone in your family has a chronic condition or needs frequent care.
- Platinum: Highest premiums, lowest out-of-pocket costs. Best if you have very high, predictable medical expenses.
Next, think about plan type. An HMO requires you to use in-network providers and get referrals for specialists. A PPO gives you more flexibility to see any doctor but costs more. An EPO is like an HMO without the referral requirement. Your choice here depends on whether keeping your current doctors is a priority.
Then check your out-of-pocket numbers. Look at the deductible (what you pay before insurance kicks in), the copays and coinsurance (your share of each visit or service), and the out-of-pocket maximum (the most you'll pay in a year). For 2026, the individual maximum is $10,600 and the family maximum is $21,200. A plan with a $500 monthly premium and a $2,000 deductible may cost less overall than a plan with a $400 premium and a $7,000 deductible, depending on how much care your family uses.
Finally, verify that your current doctors, specialists, and regular prescriptions are covered under any plan you're considering before you enroll.
This is a lot to weigh on your own. Call us at (305) 330-1277 or View available plans and we'll compare your options side by side and explain the real total cost for your family's specific situation.
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