Product identity
Major medical insurance plans: identify the coverage before comparing
Start by identifying the market, legal issuer, coverage year, benefits, exclusions, and plan documents. Similar marketing labels do not make products equivalent.
Coverage identity
Separate unlike products
Use the controlling documents and official enrollment route, not a marketing label alone.
| Route or product | Record to collect | Question to resolve |
|---|---|---|
| Marketplace plan | Official Marketplace result, SBC, policy, directory, and formulary | Is the household eligible for official savings? |
| Off-Marketplace comprehensive plan | Issuer documents, ACA status, service area, and enrollment record | Are benefits and protections comparable to the Marketplace shortlist? |
| Employer plan | Employer materials, SBC, plan document, network, and formulary | What share of premium and cost is paid by the employer? |
| Medicaid, CHIP, or Medicare | Official program decision and program-specific documents | Which program and enrollment rules control the decision? |
| Limited-benefit or temporary product | Policy, exclusions, caps, duration, renewal, and state availability | What important protection is absent or limited? |
Document stack
A summary is not the whole contract
Use the Summary of Benefits and Coverage for a standardized overview, then open the detailed policy or evidence of coverage for definitions, exclusions, authorization, appeals, and service rules.
Use separate provider and prescription records. A benefit can appear in the policy while the required provider, facility, drug, or pharmacy remains unavailable under the exact plan.
Before comparing price
Confirm comparability
- Same coverage market and plan year
- Same household and geographic assumptions
- Exact legal issuer, plan ID, and network
- Current benefit, provider, prescription, and exclusion documents
- Official savings or employer contribution recorded separately
- Clear identification of limited benefits, caps, exclusions, or temporary duration
Verification links
Primary sources
Sources checked September 3, 2026. Verify live plan, eligibility, and enrollment details with the responsible official source.