Health Plan Cost Comparison

Health Care Cost Comparison worksheet used to compare the health and pharmacy costs across different 2026 California standard metal tier design health plans.

Steps

1. Find the monthly premiums for your health plan either through Covered California or direct from the health plan.
2. Enter the dollar amounts in the green cells. Enter the number of months of enrollment if less than 12 months.
3. The yellow cells are for entering the quantity of services or prescription drugs. The green cells are for the estimated dollar cost of the service or drug if it is not subject to a set copayment.
4. The quantity entered in the yellow cells will populate across the different metal tier health plans.
5. The worksheet will automatically subtotal certain sections.
6. The blue cells indicate the dollar amount of the service is subject to a coinsurance percentage. For example, the Gold plans apply 25 percent coinsurance to the cost of imaging like an MRI.
7. If a health care service or pharmacy prescription is subject to a deductible, it will be noted. If the cost exceeds the deductible, the condition will be true and costs over the deductible amount will be subject to the coinsurance percentage of the health plan.
8. Some drug costs are limited by the plan. Silver – Platinum plans limit tier 4 drugs to a maximum of $250 for a 30-day supply. Adjustments are included in these plans to lower their total costs. The Bronze plans are limited to $500 maximum for tier 2 – 4. The worksheet does not account for the possible Bronze maximum limit but does note if the condition may be true.
9. If the health care and pharmacy cost totaled together exceed the maximum out of pocket amount of the plan, the MOOP is triggered. Instead of totaling the cost of health care and pharmacy, the worksheet will add the MOOP to the total premium amount for the total cost.
10. The two right columns are for Gold HMO and Platinum HMO plans. These plans have copayments in place of coinsurance for many health care services. For hospitalization, you will need to estimate the number of day of the hospital stay (yellow cell) to get a cost estimate.

YouTube video of instructions on how to use the worksheet.