Every November, Dan and I sit at the kitchen table after the twins go to bed, open my laptop, and try to decode health insurance. This year I promised myself I would write it down, partly for you, and partly so next-year me does not have to start from zero.
Important: I am not an insurance expert, and this is not advice. Plans, prices, and rules change every year and depend on where you live and what you earn. This is just how our family worked through it.
Our situation
I work three days a week as a hygienist, and my office does not offer health insurance to part-time staff. So our options are Dan's employer plans or buying a plan through Covered California, the state marketplace. There are four of us, the twins are nineteen months old, and we go to the doctor a lot. Ear infections, well visits, a rash that turned out to be nothing, and one memorable urgent care trip for a bead in a nose. (June. Obviously.)
How we compared
I used to look only at the monthly premium, the amount taken out of each paycheck. Now I look at three numbers for every plan:
- Premium: what we pay every month, no matter what.
- Deductible: what we pay before insurance starts covering most things.
- Out-of-pocket maximum: the most we would pay in a year for covered care, not counting premiums. Our worst-case number.
Then I add up a "normal year" and a "bad year" for each option. A normal year for us is lots of visits and a few prescriptions. A bad year is one hospital stay or a big surprise. After the twins' birth, I take the bad year seriously.
The numbers
These are family coverage numbers for 2026, rounded, from Dan's benefits portal and the Covered California estimator.
| Plan | Our monthly premium | Family deductible | Family out-of-pocket max |
|---|---|---|---|
| Dan's employer HMO | $610 | $0 | $6,000 |
| Dan's employer PPO | $890 | $1,500 | $8,000 |
| Dan's employer high-deductible plan (with HSA) | $390 | $4,000 | $10,000 |
| Covered California Silver (estimate) | $1,480 | $4,400 | $18,200 |
Why Covered California did not work for us this year
I really wanted to check the marketplace option, because I had heard from friends that it can be a good deal. For some families it is, especially if you qualify for help with the premium based on your income. When I ran our numbers through the estimator, we did not qualify for much help, and Dan's employer pays a large chunk of his plan's cost. So the Silver plan came out way more expensive every month, with a higher deductible and a much higher out-of-pocket max.
If your job does not offer coverage, or your employer's family coverage is really expensive, the marketplace could look completely different for you. It is worth running your own numbers every year.
The employer plan choice
That left Dan's three plans. The high-deductible plan had the lowest premium, and I liked the idea of putting money into a health savings account. But with two toddlers who visit the doctor constantly, we would likely hit a big chunk of that $4,000 deductible every year. In a bad year, we could owe up to $10,000 plus premiums.
The PPO gives us more choice of doctors, but we already like our pediatrician, and she is in the HMO network. Paying about $280 more every month for flexibility we would not use did not make sense for us.
So we stayed with the HMO. No deductible, simple co-pays, and a $6,000 worst case. On paper it costs more per month than the high-deductible plan, but for our actual life with lots of visits, it came out ahead in both my normal-year and bad-year math.
What I would do the same next year
- Log in early, as soon as open enrollment starts, so we are not rushing.
- Pull last year's claims from the insurance website to see what we actually used.
- Check that our pediatrician, my doctor, and the nearest urgent care are in network.
- Run the normal-year and bad-year totals for every option, including the marketplace.
- Ask Dan's HR if anything is changing, because premiums went up about $40 a month this year.
It is not a fun date night. But an hour at the kitchen table in November has saved us from some very unfun surprises, and I sleep a little better knowing our worst-case number.
