The many available choices in the U.S. commercial insurance market, combined with the unique complexities of the current healthcare market, create a complex cause-and-effect matrix that is reflected in a range of different health plan costs. This paper examines five types of plan design and the costs associated with them, and includes an analysis of the many variables at work. The paper also cautions that actuarial considerations must be used in the proper context if they are to support an effective healthcare reform effort.