How to Compare Health Plans Using the Summary of Benefits and Coverage
Learning goal: Use the Summary of Benefits and Coverage to compare plans side by side on deductibles, out-of-pocket limits, networks and the two coverage examples, so you choose on real costs.
Short answer
Use each plan's Summary of Benefits and Coverage (SBC). Insurers and job-based plans must provide this short, plain-language summary, in the same format for all plans, so you can compare deductibles, copays, out-of-pocket limits and networks side by side. Its coverage examples show what each plan would pay for diabetes care and childbirth.
Read to the end to complete this lesson.
On this page
The Fuller Picture
HealthCare.gov calls the SBC a way to make "apples-to-apples" comparisons. Line up the deductible, the out-of-pocket maximum, the copays for care you use, whether specialists need referrals, and the drug tiers. Then read the two coverage examples. You can ask any insurer or employer plan for an SBC at any time.
Key Takeaways
- HealthCare.gov: "You have the right to an easy-to-understand summary about a health plan's benefits and coverage."
- Insurers and job-based plans must provide the SBC and a Uniform Glossary of terms.
- The SBC's coverage examples show what the plan would pay in 2 common situations: diabetes care and childbirth.
- You can ask your insurer or plan for a copy at any time.
- Compare total costs: premiums plus what you'd pay for the care you expect.
Real-World Example
Grace
Grace's employer offers two plans. The SBCs show Plan 1 has a $500 deductible and a $4,000 out-of-pocket maximum; Plan 2 has a $2,000 deductible and a $7,000 maximum but a lower premium. Grace takes a daily medication, so she compares the drug copays too. Plan 1 costs more each month but less over a year for her.
Common Mistakes
- Comparing premiums only.
- Not checking the out-of-pocket maximum, your worst-case year.
- Skipping the coverage examples.
- Not asking for the SBC of an employer plan.
Interactive Exercise
Line Up Two SBCs
Get the Summary of Benefits and Coverage for two plans and compare these lines.
Tick each step as you do it. Your checklist is saved in this browser.
Knowledge Check
Question: What does the Summary of Benefits and Coverage's coverage examples section show?
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Questions to explore next
Questions readers often ask next about this topic:
- How do I read my plan's Summary of Benefits and Coverage?
- Which plan costs less for the care I use?
- Where do I find a plan's drug list?
- What do the coverage examples tell me?
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The factual claims on this page were checked against these sources. Rules and figures change, so check the source itself if you need to confirm the current version.
- healthcare.govSummary of Benefits and Coverage · HealthCare.gov (U.S. Centers for Medicare & Medicaid Services)
Educational information, not advice: This lesson is for general education only, not legal, financial, or insurance advice. Actual coverage, discounts, and requirements depend on your policy’s wording, your insurer, and the laws of your state. Confirm specifics with your own insurer or a licensed agent before making a decision. Insurpedia does not sell insurance and does not recommend specific insurers. The SBC rules and coverage examples are from HealthCare.gov. Plans differ; the SBC summarizes, and the policy governs. Educational information, not advice on a specific plan.