Picking a Health Plan? Check the Hospital's Prices First

Key takeaways

• The premium is not the price of your care. A cheap monthly premium usually comes with a high deductible — and until you meet it, you pay the hospital's price yourself.
• Look up the prices first. Before you pick a plan, check what the care you expect actually costs at hospitals near you. The same scan can cost several times more at one hospital than another.
• Work the math for your year, not just the premium. Add up premium + deductible + what you would pay for the care you expect. The "cheap" plan often loses once real care enters the picture.
• Enroll by December 15, 2026 for coverage starting January 1, 2027. The last day to enroll for 2027 coverage on HealthCare.gov is January 15, 2027.

Open enrollment for 2027 health coverage is open now on HealthCare.gov — November 1, 2026 through January 15, 2027, according to the Centers for Medicare & Medicaid Services (CMS). If you buy your own insurance, this is the window when you choose next year's plan. Most people compare plans by the monthly premium. That is the wrong number to start with.

The premium is what you pay every month whether you get care or not. The deductible is what you pay out of your own pocket before the plan starts paying — and it is usually the bigger number. In KFF's 2025 survey of employer health plans, the average deductible for single coverage was $1,886, and about a third of covered workers had a deductible of $2,000 or more. Until you have paid that much, the hospital's price is your price.

That is why the hospital's prices belong in your plan decision. The same procedure can cost several times more at one hospital than at another, and your plan choice decides how much of that gap lands on you.

What one scan costs at different hospitals

Our database holds prices published by 1,062 hospitals — 300,940 rates across 426 procedures. Take a common scan, an MRI of the brain without contrast:

• The median cash price across 697 hospitals is $1,426.
• Cash prices run from under $100 to over $10,000 for the same scan.
• The median rate hospitals negotiated with insurers is lower, about $620 — but negotiated rates also vary widely, from about $98 to nearly $5,900.

A CT scan of the abdomen and pelvis with contrast shows the same pattern: a median cash price of $2,059 across 818 hospitals, with cash prices running from about $28 to over $18,300.

Two lessons follow. First, the hospital you go to matters as much as the plan you pick. Second, your plan's deductible decides whether that price difference comes out of your pocket or your insurer's. You can look up the procedure on Patients Price to see what hospitals near you report charging — do it before you choose, not after the bill arrives.

A worked example: the cheap plan can cost more

Say you expect one MRI of the brain this year, and the hospital charges the median cash price of $1,426. Two plans are on offer (premiums here are made-up round numbers to show the math — use your real quotes):

• Plan A: $300 a month ($3,600 a year), $5,000 deductible.
• Plan B: $450 a month ($5,400 a year), $1,000 deductible, and the plan pays 80% of costs after the deductible.

With just the one MRI:

• Plan A: $3,600 in premiums + the full $1,426 MRI, because you have not met the $5,000 deductible = $5,026. The plan pays nothing toward the scan.
• Plan B: $5,400 in premiums + $1,000 of the MRI (your deductible) + 20% of the remaining $426 = $6,485. The plan pays $341.

Plan A wins by about $1,460 — because you needed little care.

Now say you also need a CT scan of the abdomen and pelvis, median cash price $2,059. Your care now totals $3,485.

• Plan A: $3,600 + $3,485 = $7,085. You still have not met the $5,000 deductible, so you pay for all of it.
• Plan B: $5,400 + $1,000 deductible + 20% of the remaining $2,485 = $6,897. The plan pays $1,988.

Plan B now wins by about $190. Same two plans, same prices — the answer flipped because the amount of care changed. That is the rule: the cheapest plan depends on how much care you expect. A low premium wins when you need little care; a lower deductible wins when you need more. Estimate your year first, then do this math with your real premiums and deductibles.

Four checks before you pick

1. Are your hospitals and doctors in the plan's network? A plan can be cheap because its network is narrow. If your hospital is out of network, the plan may pay little or nothing for planned care there — and the federal surprise-billing protections do not cover a hospital you chose knowing it was out of network (see Your Rights Against Surprise Bills). Check the plan's provider directory, then call the hospital to confirm it takes that exact plan — directories are sometimes out of date.

2. What is the deductible — and the out-of-pocket maximum? The deductible is what you pay first. The out-of-pocket maximum is the most you can be asked to pay in the year, after which the plan pays everything covered. Both numbers are in the plan's Summary of Benefits. If you take regular prescriptions, check the drug list too: a drug your plan does not cover is a cost the premium never touches.

3. What does your care actually cost? List the care you expect next year — a scan, a procedure, a prescription — and look up each one on Patients Price before you choose. An MRI of the brain without contrast and a CT scan of the abdomen and pelvis with contrast are good places to start. If you pay cash for a visit because the cash price beats your plan's rate, read Should You Use Your Insurance — or Pay Cash? first: cash payments usually do not count toward your deductible.

4. Could financial assistance cover what insurance does not? Even with insurance, a big deductible can leave you owing thousands — and hospitals may still help. Nonprofit hospitals must offer financial assistance, and many offer free or discounted care to patients earning well above the poverty line. Our financial-assistance screening tool checks your household size, income, and ZIP code against the policies of 852 hospitals and tells you whether you might qualify. If you might, apply before you pay anything (see You Might Not Have to Pay That Hospital Bill).

Two honest caveats

• Prices are what hospitals publish, not a promise. A hospital's published price is the starting point for what you may owe, and your plan's negotiated rate for that hospital can differ from both the cash price and the median. Ask the hospital and your plan for your exact cost before scheduled care — and get a Good Faith Estimate in writing if you are paying yourself (see If the Bill Is $400 Over Your Good Faith Estimate, You Can Dispute It).
• Help with premiums changed for 2027. The extra federal premium assistance available through 2025 has ended, so some shoppers will see higher premiums than last year. Check what help you qualify for on HealthCare.gov itself rather than assuming last year's numbers still apply. State-run marketplaces can also have different deadlines — confirm the dates on your state's own site.

The bottom line

1. Do not pick a plan on the premium alone. Add premium + deductible + your expected care, using real hospital prices.
2. Look up your expected care first — the same scan can cost several times more at one hospital than another, and your deductible decides who pays the difference.
3. Check the network — your hospital and doctors must take the exact plan you are buying.
4. Check financial assistance — even with insurance, you may qualify for free or discounted care at your hospital.
5. Enroll by December 15, 2026 for coverage starting January 1,
6. The final deadline is January 15, 2027.

Sources: U.S. Centers for Medicare & Medicaid Services, Plan Year 2027 Marketplace Plans and Prices Fact Sheet (open enrollment November 1, 2026–January 15, 2027); KFF, 2025 Employer Health Benefits Survey (average single deductible $1,886; 34% of covered workers with a deductible of $2,000 or more); hospital prices from the Patients Price database — 1,062 hospitals, 426 procedures, 300,940 rates (data as of November 2026). MRI brain without contrast (CPT 70551): median cash price $1,426 across 697 hospitals; CT abdomen and pelvis with contrast (CPT 74177): median cash price $2,059 across 818 hospitals. Premium figures in the worked example are illustrative, not quotes. This is general information, not insurance advice. For help choosing a plan, contact HealthCare.gov or your state's marketplace.