November 3, 2026
By Cece Lin | SteadyAdulting
Many of us get health insurance through our workplaces, or at least have the option. But sometimes things get complicated.
Perhaps you recently started a new job and must complete a waiting period before your health insurance begins. Maybe your employer reduced your hours, eliminated certain benefits, or changed your position to part-time. Perhaps you are self-employed, between jobs, or simply need to purchase your own insurance.
Whatever your reason for shopping through the Health Insurance Marketplace, there are several things to consider before selecting a policy.
Health insurance is not just another monthly bill. It is something you hope you will not need very often, but when you do need it, you want it to work.
Before comparing plans, take a little time to evaluate your personal circumstances and gather the information you will need.
First, Know Your Enrollment Dates
For health insurance coverage beginning in 2027, Open Enrollment through HealthCare.gov runs from November 1, 2026, through January 15, 2027.
December 15, 2026: Enroll by this date for coverage beginning January 1, 2027.
January 15, 2027: Final day of regular enrollment through HealthCare.gov. Coverage selected after December 15 generally begins February 1.
Some states operate their own Marketplaces and may have different deadlines. Confirm yours before shopping.
Now, what should you consider?
1. Age and Stage of Life
Certain medical screenings and preventive services become recommended as we get older.
For example, breast cancer screening mammograms are generally covered as preventive care every one to two years for women aged 40 and older. A diagnostic mammogram ordered because of a symptom may be billed differently.
Other age-related preventive services include screenings for certain cancers, diabetes, cardiovascular risks, and bone health, depending on medical guidelines and individual circumstances.
Your stage of life matters, too.
If you are planning to become pregnant, you may want to consider access to obstetricians, hospitals, prenatal care, and other maternity services.
All Marketplace plans cover pregnancy, maternity, and newborn care as essential health benefits. However, the participating doctors, hospitals, deductibles, and other out-of-pocket expenses can differ considerably.
Before shopping: Write down your age-related screening needs, reproductive health plans, and any appointments or procedures you expect in the coming year.
2. Your Current State of Health
Someone who is generally healthy, physically active, and rarely visits a doctor may not have the same insurance priorities as someone managing several ongoing medical conditions.
For example, a person who typically sees a doctor only for preventive care might be comfortable considering a plan with lower monthly premiums and a higher deductible.
On the other hand, someone who regularly sees specialists, undergoes laboratory testing, or requires ongoing treatment may want a plan with more predictable medical expenses.
That does not necessarily mean choosing the most expensive insurance available.
It means comparing what the different plans actually provide and what you would be responsible for paying.
Remember, however, that being healthy today does not guarantee that you will remain healthy throughout the coming year. Accidents, injuries, infections, and unexpected diagnoses happen.
When comparing plans, consider what you can afford during an ordinary year and during a year when medical expenses become unexpectedly high.
Before shopping: Make a list of your current medical conditions, expected appointments, ongoing treatments, and anticipated medical expenses.
You do not need to submit your medical history to the Marketplace to determine your premium. This information is for your own planning.
3. Your Everyday Health Practices
Now consider your daily routine.
Are you physically active? Do you spend most of the day sitting? Do you work long hours and occasionally skip meals? Do you regularly rely on fast food because you have little time or energy to prepare meals?
Do you smoke, drink alcohol frequently, or experience ongoing stress?
These circumstances can affect health over time, although they do not automatically mean that someone is unhealthy or will need extensive medical treatment.
For instance, someone concerned about blood pressure, cholesterol, blood sugar, smoking-related risks, or other health issues may want to make sure the plan provides reasonable access to primary care, recommended screenings, and appropriate specialists.
Someone dealing with persistent stress, anxiety, or other emotional health concerns may want to examine the plan's mental health provider network.
There is no reason to judge yourself or anyone else for their lifestyle. The purpose is to be realistic about the care you may need.
One important insurance distinction: Marketplace companies cannot raise your premium simply because you are less physically active, have a medical condition, or have a particular medical history. However, tobacco use may affect premiums, depending on state rules.
Before shopping: Consider whether you anticipate preventive screenings, counseling, medication, or additional medical visits related to your health concerns.
4. Your Family Medical History
Your family history may tell you something important about your own health risks.
Consider your parents, grandparents, siblings, aunts, uncles, and other close blood relatives.
Have several family members developed similar medical conditions? Have multiple relatives experienced heart disease, diabetes, certain cancers, autoimmune conditions, or other serious illnesses?
Did any relatives develop these conditions at unusually young ages?
Do you know what caused the deaths of close family members?
A family history of illness does not mean you are destined to develop the same condition. However, it can help your physician determine whether you may benefit from earlier screening, more frequent monitoring, or additional medical evaluation.
For example, a family history of certain cancers may influence screening recommendations. A strong family history of cardiovascular disease or diabetes may also be relevant to your preventive care.
When possible, write down:
Which relative had the condition
What condition was diagnosed
Approximately how old the relative was when diagnosed
Whether several relatives experienced similar problems
The age and cause of death, when known
Share relevant information with your healthcare provider.
Marketplace plans cannot deny you coverage or raise your premium because of your family medical history or pre-existing conditions.
Before shopping: Gather your family medical history and discuss any concerns about screening with your physician. Consider whether your preferred providers and expected services are available within the plans you are comparing.
5. Your Doctors, Specialists, and Medications
This is one of the most important parts of selecting health insurance.
Make a list of the doctors and medical facilities you currently use or expect to need.
Include your primary care physician, specialists, preferred hospitals, pharmacies, and any other regular providers.
Then list your prescription medications, including the names, dosages, and how frequently they need to be refilled.
Not every doctor accepts every insurance plan, even when multiple plans are offered by the same company.
For example, a physician may accept one plan from an insurer but not another.
Some plans also require referrals to specialists, while others allow you to schedule specialist appointments without a referral. Certain plans provide out-of-network coverage at a higher cost, while others generally do not cover nonemergency out-of-network care.
If you anticipate needing specialists, comparing these differences can be particularly important.
Before shopping: Check provider networks, prescription drug lists, referral requirements, and any prior authorization rules.
Do not assume your current doctors or medications will automatically be covered.
6. Your Household and Income Information
Marketplace applications require information about your household and expected income.
Gather the names, birth dates, addresses, and relevant identification information for household members and tax dependents.
You may also need recent pay statements, tax records, information about other income, or self-employment records.
Most importantly, estimate your household income for 2027, the year you are seeking coverage.
If you are self-employed, consider your expected business income after allowable business expenses.
If your income changes because of a new job, reduced hours, a raise, or another development, update your Marketplace application.
Financial assistance may be available depending on eligibility, household circumstances, and income. Inaccurate income estimates can affect the assistance you receive and may result in money being owed when you file your taxes.
Before shopping: Gather your financial documents and prepare a realistic estimate of next year's household income.
7. Your Current or Employer-Offered Insurance
If you currently have health insurance, gather your policy information and renewal notices.
If your employer offers coverage, obtain details about the plan, employee premiums, dependent coverage, and eligibility requirements.
Some employers have waiting periods before benefits begin. Under federal rules, a group health plan generally cannot impose a waiting period exceeding 90 days once an employee meets the plan's applicable eligibility conditions.
However, employees who do not meet eligibility requirements, such as certain part-time workers, may not qualify for that employer's plan.
Also remember that access to an affordable employer-sponsored plan meeting minimum-value standards can affect eligibility for financial assistance through the Marketplace.
Before shopping: Know exactly what coverage you already have, what your employer offers, and when any existing coverage begins or ends.
8. Your Actual Healthcare Budget
When comparing insurance plans, do not stop at the monthly premium.
A plan advertising a low monthly payment may look attractive until you need laboratory testing, imaging, specialist appointments, or an unexpected hospital visit.
Consider these four major costs:
Monthly premium: What you pay every month to maintain your insurance.
Deductible: What you may have to pay for certain covered services before your insurance begins paying its share.
Copayments and coinsurance: The portion you pay when receiving covered care.
Out-of-pocket maximum: The annual limit on what you pay for covered, in-network services under your plan. Monthly premiums and certain other expenses do not count toward this limit.
For some people, a lower-premium plan will make sense. For others, paying more each month may reduce anticipated out-of-pocket expenses.
The important question is not simply, "What is the cheapest insurance?"
It is:
"What will this insurance realistically cost me over the year, and can I afford to use it when I need care?"
SteadyAdulting: Before-You-Shop Checklist
Gather this information before starting your Marketplace application.
Your state's Open Enrollment dates
Personal identification and household information
Estimated household income for 2027
Recent pay statements or self-employment records
Current insurance policy and renewal information
Details of any employer-sponsored insurance offer
Names of preferred doctors and specialists
Preferred hospitals and pharmacies
Current prescription medications and dosages
Expected medical appointments, screenings, or procedures
Relevant family medical history
Anticipated healthcare needs
A realistic monthly insurance budget
An estimate of potential deductibles and out-of-pocket expenses
Where Should You Start?
Visit HealthCare.gov to begin. If your state operates its own Marketplace, HealthCare.gov can direct you to the appropriate website.
You can review available plans, compare estimated costs, and determine whether you may qualify for financial assistance.
If you need help, the Marketplace also provides access to trained enrollment assistance.
Be cautious about sharing sensitive personal or financial information with unfamiliar websites or unsolicited callers.
If you qualify for Medicaid or the Children's Health Insurance Program (CHIP), applications are available throughout the year. Medicare has a separate enrollment system.
The SteadyAdulting Takeaway
Health insurance is one of those purchases you hope you will not need very much, but you certainly do not want to discover its limitations when you are already sitting in a doctor's office or hospital.
Take the time to gather your information, understand your circumstances, and compare what different plans will actually cost.
You do not need the fanciest or most expensive policy available. You need coverage that meets your needs, fits your budget, and gives you reasonable access to care.
Steady Tip: Do not choose health insurance based only on what it costs to have it. Consider what it will cost to use it.
Official Resources
Disclaimer: This article provides general educational information and is not medical, legal, tax, or insurance advice. Coverage, costs, eligibility, and enrollment deadlines may vary by state and plan. Verify details through the official Marketplace and individual insurance documents before enrolling.