Open Enrollment: What to Review Before You Choose

Every fall, many people get a once-a-year chance to change their health coverage. This window is called open enrollment. It’s easy to let it pass and keep the same plan, and sometimes that’s the right choice. But your needs, your plan, and its costs can all change from one year to the next. A short review now can help you avoid surprises later. This post walks you through what to look at, step by step. EverydayBenefitGuide doesn’t sell insurance or recommend plans. We just help you know what questions to ask.

Which open enrollment applies to you?

There isn’t just one open enrollment. The dates depend on where your coverage comes from.

• Health Insurance Marketplace: For plans through healthcare.gov, open enrollment usually runs from November 1 into mid-January. Some states run their own marketplace with different dates.
• Employer plans: Your employer sets its own window, often in the fall. It may be only a few weeks long.
• Medicare: The Medicare Open Enrollment Period generally runs from October 15 to December 7.
• Medicaid and CHIP: These don’t have an open enrollment period. You can apply any time of year.

Check the exact dates on the official site or with your HR department. Missing the window usually means waiting another year, unless you have a life event that opens a special enrollment period.

Step 1: Read your plan’s change notice

Before open enrollment, plans usually send a notice describing what’s changing next year. For Medicare plans, this is called the Annual Notice of Change. Employer plans often share a benefits guide or summary.

Look for changes in:

• Your monthly premium
• Your deductible and out-of-pocket maximum
• Which doctors, hospitals, and pharmacies are in network
• Which prescriptions are covered and at what cost

If you didn’t get a notice, contact your plan or HR team and ask for one.

Step 2: Think about the past year

Your past year is one of the best guides for the next one. Take a few minutes to remember:

• How many times did you or your family see a doctor?
• Did anyone see a specialist, have a procedure, or go to urgent care?
• Which prescriptions does each person take regularly?
• Did you hit your deductible? Did you come close to your out-of-pocket maximum?

Then think ahead. Are you expecting a baby, planning a surgery, or managing a new health condition? These can change which plan fits best.

Step 3: Compare the full cost, not just the premium

A low monthly premium can look appealing. But the premium is only part of what you pay. To see the bigger picture, look at:

• Premium: What you pay each month, whether or not you use care.
• Deductible: What you pay for covered care before the plan starts sharing costs.
• Copays and coinsurance: Your share of the cost for each visit or service.
• Out-of-pocket maximum: The most you’d pay for covered care in a year.

A plan with a higher premium and a lower deductible might cost less overall if you expect to use a lot of care. A plan with a lower premium might make sense if you rarely see a doctor. Our guide to insurance terms explained breaks these words down with simple examples.

Step 4: Check your doctors and prescriptions

Networks and drug lists can change each year. Don’t assume your doctor is still in network just because they were last year.

• Use the plan’s online provider search to look up each doctor you see.
• Call the doctor’s office to confirm they’ll accept the plan next year.
• Check the plan’s drug list, sometimes called a formulary, for each medicine.
• Note which “tier” each drug is on, since that affects your cost.

Step 5: Look at savings on Marketplace plans

If you buy coverage through the Marketplace, you may be eligible for help paying premiums based on your household income and size. This help is often called a premium tax credit. Some people may also be eligible for lower out-of-pocket costs on certain plans.

Your eligibility can change if your income or household changes, so it’s worth updating your application each year rather than letting it renew automatically. Check the current eligibility rules on healthcare.gov.

Step 6: Review the extras

Some plans include benefits beyond medical care. Depending on the plan, you might see:

• Dental and vision coverage
• Mental health services and telehealth visits
• Health savings accounts (HSAs) or flexible spending accounts (FSAs)
• Wellness programs

If your employer offers an FSA, remember that you usually need to choose to sign up again each year.

Step 7: Update your information

Open enrollment is also a good time to make sure your details are correct. Check:

• Your mailing address, email, and phone number
• Your dependents, especially if a child is aging off your plan
• Your beneficiaries for any life insurance offered through work

A note on calls and texts

During open enrollment, you may get calls or messages from people offering to “help” you pick a plan. Be careful. Real agencies like Medicare won’t call you out of the blue asking for your Medicare number. Our post on government imposter scams explains common red flags. When in doubt, go directly to healthcare.gov, medicare.gov, or your HR department.

Where to get trusted help

You don’t have to figure this out alone. Free, unbiased help is available:

• Marketplace: healthcare.gov lists trained local helpers, sometimes called navigators.
• Medicare: Your State Health Insurance Assistance Program (SHIP) offers free counseling.
• Employer plans: Your HR or benefits team can explain your options.

For a broader yearly review that also covers auto, renters, and life insurance, see reviewing your coverage each year. And if you’re new to the topic, our health coverage basics guide is a good place to start.

The bottom line

Open enrollment is your yearly chance to make sure your coverage still fits your life. Read your change notice, think about the past year, compare full costs, and confirm your doctors and prescriptions. Mark your deadline on the calendar and use official sources for final details. A little time now can bring real peace of mind for the year ahead.