How to Choose the Right Healthcare Plan for You in 2026

If you haven’t started already, it’s time to think about your healthcare plan options for 2026, especially as we get further into the year. Whether you’re planning to sign up for, change, or renew a plan, our guide can help inform your decision.

There are many factors to consider when selecting health insurance, especially with the premium tax credit changes this year. It’s important to do research on the plans you’re interested in, consider your budget, pre-existing conditions, and waiting periods.

Getting a better idea of your personal health situation, whether by talking to your GP or someone who has completed BSN MSN programs, can also be beneficial. It can better equip you to make sure you get the right plan with the right coverage you need.

What is a healthcare plan?

A healthcare plan is similar to other types of insurance, like for your car or pet, but for your body. It’s a contract with an insurer that can help pay for medical expenses, doctor visits, hospital stays, and prescriptions. 

A healthcare plan involves regular fees, such as a monthly “premium”, and shared costs for medical services. The shared cost and coverage will depend on the plan, and they typically come in four different categories, named after metals.

The health insurance marketplace

The health insurance Marketplace is a tool that helps you find health coverage that suits your needs and budget. It makes it easier to compare plans based on pricing, coverage, and networks.

The health insurance Marketplace was established by the Affordable Care Act to help individuals and families find affordable health insurance. Plans available through the Marketplace are known as “Marketplace” plans.

Along with being able to browse and compare plans, the Marketplace also offers assistance in finding a plan. This includes tools to calculate costs, check for savings qualification, and systems to find an agent/broker. 

What are the different categories?

Health insurance plans commonly come in four different categories. These categories show how you and your plan share costs; they do not represent the quality of care or coverage. These categories are:

• Bronze
• Silver
• Gold 
• Platinum

The higher the level of the category, e.g., Platinum, the more the plan pays for covered services. Depending on where you live and your circumstances, there is sometimes a fifth level available, Catastrophic plans. Eligibility is only available to people:

• Under 30 years old
• Over 30 years old and don’t qualify for savings on a Marketplace plan
• Who qualifies for a hardship or affordability exemption

The Marketplace’s income calculator can be a handy tool for figuring out your household’s yearly income and expenses.

Enhanced tax credits 

When selecting a healthcare insurance plan, it’s important to remember that the Enhanced Affordable Care Act (ACA) premium tax credits expired on January 1st, 2026. So, premium prices will be higher for plans going forward.

What is a plan network?

There is a wide variety of Marketplace health insurance plans designed to meet different needs. Some plans may restrict or encourage where you get care from. This is known as the plan’s network.

For example, some plans are designed to only provide coverage from certain doctors, hospitals, pharmacies, or other medical service providers. If you get care from a provider outside of this network, the insurance may cover less of the cost (or none at all).

Strategies for picking the right coverage

When it comes to finding the right health insurance for you, there’s more to consider than just the premium.

Research the covered drug list

If you take or are planning to take any prescription medications, that should be one of the first things you consider when choosing a plan. Each health plan will have its own provider network and covered drug list; always check and compare this with other plans.

The covered drug list can differ significantly between plans. It’s also possible for the list to change between plan tiers. Similarly, if you’re switching to a new plan from the same insurer, don’t assume the same drugs will be covered, and the costs will be the same. Always do research.

Look at the ratings

The Marketplace uses a quality ratings system to help users choose between plans. These ratings use a star system, and plans can score between one and five. Five stars is the highest performing health plan.

A health care plan’s rating is based on numerous factors, including the quality of health care services and members’ experiences. A deeper view into how the rating is calculated is covered below.

Member experience: Based on surveys of member satisfaction, which include ease of getting appointments, and their experiences with accessing medical services.

Medical care: Based on how well the plan’s network providers manage member health care, e.g., by providing regular screenings.

Plan administration: Based on how well the plan is operated, such as customer service. 

All health care plans are rated using the same system and based on the previous year’s data. In cases where a rating isn’t available (e.g., new or low enrollment), this doesn’t mean the plan is low quality—there just isn’t enough data yet. 

Check with your state’s insurance department

For extra reassurance, alongside checking quality ratings on the Marketplace, consider checking potential insurers and plans with your state’s insurance department. This department regulates all of the health insurers on the Marketplace.

The insurance department sometimes publishes overviews of any complaints issued against an insurer operating in its state. This can be an effective way to gain further insight into whether a healthcare plan is right for you.

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