The Summary of Benefits and Coverage (SBC) is designed to help consumers compare key features of health plans. It summarizes important information such as deductibles, cost-sharing, covered services, and examples used to illustrate how a plan might share costs.
Start with the key figures
Look for individual and family deductibles, copayments, coinsurance, and the out-of-pocket maximum. Check how the plan treats office visits, emergency care, hospital services, specialist visits, and prescription drugs. Do not assume the same deductible applies to every service.
Read exclusions and definitions
The SBC is a summary, not the entire policy. Review the detailed coverage document for benefit limitations, network rules, referrals, prior authorization, and exclusions. Use the insurer's provider directory and formulary separately.
Use it for side-by-side comparisons
Compare documents for the same coverage year and similar plan options. The cheapest premium may not be the least expensive overall. The official Marketplace plan preview can help you locate plan options, but always review the exact documents before enrolling.