Open enrollment is your once-a-year window to choose health insurance — and for most people, it is also the most consequential financial decision they make all year. The wrong plan can cost thousands in surprise bills or lock you out of your doctors. The right plan fits your health needs, your budget, and your life. Here is a step-by-step process for how to choose health insurance during open enrollment.
Table of Contents
- When Open Enrollment Happens
- Step 1: Audit Last Year’s Health Care Use
- Step 2: Check Your Doctors and Drugs
- Step 3: Compare Total Costs, Not Just Premiums
- Step 4: Evaluate Plan Types and Networks
- Step 5: Check Subsidies and Tax Advantages
- Common Mistakes to Avoid
- Key Takeaways
When Open Enrollment Happens
For ACA marketplace plans, open enrollment typically runs from November 1 through mid-January, with coverage starting January 1 for those who enroll by the December deadline. Employer plans set their own windows — usually a few weeks in the fall — and Medicare’s annual open enrollment runs October 15 to December 7. Miss your window and you are generally locked in until next year, unless you qualify for a special enrollment period.
The single biggest mistake is auto-renewing without shopping. Plans change every year: premiums rise or fall, networks shift, formularies get revised, and your own health needs evolve. Insurers count on inertia — a large share of enrollees simply let their plan roll over. Even if you loved your plan last year, spend an hour confirming it is still your best option.
Key dates and plan details for marketplace coverage are published on HealthCare.gov, and usa.gov maintains a central hub linking to enrollment resources for marketplace, employer, and Medicare coverage.
Step 1: Audit Last Year’s Health Care Use
Before comparing plans, look backward. Pull together last year’s medical spending: how many primary care and specialist visits, any ER trips or hospital stays, ongoing prescriptions, planned procedures, therapy or mental health visits. Your insurer’s online portal or your explanation-of-benefits statements will have the details.
Then look forward. Are you planning a surgery, expecting a baby, starting a new medication, or managing a chronic condition? Anticipated care matters more than last year’s care for choosing cost-sharing levels. A planned knee replacement argues for a low-deductible plan even if last year was quiet; a healthy year ahead argues for banking premium savings.
Write down your must-haves: specific doctors, hospitals, and prescriptions you cannot do without. These become your non-negotiable filters in the steps ahead — a plan that fails any of them is eliminated regardless of price.
Step 2: Check Your Doctors and Drugs
Network and formulary checks eliminate more plans than any other step. For each finalist plan, verify that your primary care doctor, specialists, preferred hospital, and pharmacy are in-network. Do this on the insurer’s own provider directory — not a third-party site — and consider calling the doctor’s office to confirm, since directories can lag behind contract changes.
For prescriptions, check the plan’s formulary: the list of covered drugs organized into cost tiers. Confirm each of your medications is covered and note its tier, since a drug’s tier determines your copay or coinsurance. Our guide to prescription drug tiers and formularies explains how to read these lists and what to do if a drug is not covered.
Pay special attention if anyone in your household sees out-of-area providers — college students, frequent travelers, or family members splitting time between homes. A narrow local network that works fine at home can become a serious problem two states away.
Step 3: Compare Total Costs, Not Just Premiums
The premium is the most visible number and the most misleading one. A low premium with a $7,000 deductible can cost far more over the year than a higher premium with a $1,000 deductible — it all depends on how much care you use. The right comparison is total annual cost: premiums plus expected deductibles, copays, and coinsurance.
Build a simple estimate for each finalist plan. Start with twelve months of premiums. Add your expected cost-sharing using last year’s utilization as a guide — most marketplace and employer tools will estimate this for you if you enter your expected services. Then stress-test: what does a bad year cost (out-of-pocket maximum plus premiums)? The plan with the lowest worst-case total is often the smartest choice for anyone with health risks.
If the terminology is tripping you up, our plain-language guide to deductibles, copays, and coinsurance walks through exactly how these costs stack up, and our HSA vs. FSA comparison covers the tax-advantaged accounts that pair with many plans.
Step 4: Evaluate Plan Types and Networks
With costs estimated, consider the plan’s structure. HMOs cost less but require a primary care gatekeeper and cover only in-network care; PPOs cost more but let you see any doctor without referrals; EPOs split the difference. The right structure depends on how much you value choice versus savings — there is no universally correct answer.
Also check the extras that matter to you: telehealth coverage and copays, mental health benefits and therapist networks, dental and vision add-ons, wellness programs, and whether the plan offers a health savings account (HSA) option. High-deductible plans paired with HSAs offer a triple tax advantage that makes them compelling for healthy, higher-income savers — but only if you actually fund the HSA.
For marketplace shoppers, metal tiers summarize generosity: Bronze covers roughly 60 percent of average costs, Silver 70, Gold 80, Platinum 90. But remember that cost-sharing reductions — available only on Silver plans for lower-income buyers — can make Silver the best value by far for those who qualify.
Step 5: Check Subsidies and Tax Advantages
Marketplace shoppers should never skip the subsidy check. Premium tax credits are calculated from your estimated income when you apply, and they can cut premiums dramatically — many enrollees pay well under $100 a month after credits. Getting your income estimate right matters: underestimate and you may owe money back at tax time; overestimate and you leave money on the table.
Employees should review pre-tax advantages: premiums paid through payroll come out before taxes, effectively discounting them by your marginal tax rate. Flexible spending accounts (FSAs) and HSAs let you pay cost-sharing with pre-tax dollars too. These tax effects can shift the math between plans, so factor them in before deciding.
Free help exists at every step: marketplace navigators, employer benefits counselors, and state insurance department hotlines all provide unbiased guidance. The Centers for Medicare and Medicaid Services also publishes plan-comparison tools and educational materials for shoppers.
