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Open enrollment is the one time each year when you can change your health insurance plan without needing a qualifying life event. It is also the one time most people spend the least time thinking about it, auto-renewing the same plan out of habit. Plans change every year: premiums move, networks shift, formularies update. Spending an hour on this checklist can save you real money and prevent an ugly surprise in January.
1. Check whether your doctors are still in network
Provider networks change every year. A doctor who was in network last year might not be this year, and out-of-network care can cost dramatically more or not count toward your deductible at all. Look up each doctor you see regularly, your primary care physician, specialists, and any facility where you have ongoing treatment, in the new plan year’s directory. Do not rely on last year’s list or the doctor’s office’s word alone; verify with the insurer.
2. Confirm your prescriptions are still covered
Formularies, the lists of covered drugs, change annually. A medication that was a cheap generic-tier copay can move to a higher tier or require prior authorization. Look up every regular prescription in the new formulary and note the tier and any restrictions. If a drug moved tiers, ask your doctor about alternatives before enrollment closes.
3. Compare the total cost, not just the premium
The premium is the most visible number and the least complete. Add the annual premium to the deductible and the out-of-pocket maximum to see your best-case and worst-case costs. A plan with a low premium and a high deductible is cheap in a healthy year and expensive in a bad one. Estimate which kind of year you are likely to have based on planned procedures, ongoing conditions, and regular prescriptions, then compare the totals.
4. Understand the deductible changes
Deductibles rarely stay flat year to year. Check whether yours went up, and whether the plan still applies the deductible the same way. Some plans exempt certain services from the deductible, like preventive visits or a set number of primary care appointments. Others apply it to nearly everything. Two plans with the same deductible number can behave very differently.
5. Check the out-of-pocket maximum
This is your worst-case number for the year, and it is the figure that matters most if something serious happens. Confirm it did not rise significantly, and check whether copays count toward it. Plans that exclude copays from the maximum can cost more than they appear for people with frequent visits.
6. Review HSA and FSA options
If you are considering a high-deductible plan, check whether it is HSA-eligible. Health savings accounts offer tax advantages that change the math considerably, and employer contributions to your HSA are effectively free money. If you have an FSA, remember the use-it-or-lose-it rules and estimate your contribution based on predictable expenses like prescriptions, dental work, and vision care rather than guessing.
7. Look at dental and vision separately
Dental and vision plans are often separate enrollments with their own open enrollment windows. Dental plans have annual maximums that are easy to hit with a single crown or root canal, so check whether the maximum changed. Vision plans matter if you wear glasses or contacts; compare the frame and lens allowances against what you actually spent last year.
8. Update your family and life changes
Marriage, divorce, a new baby, a child aging off your plan, a spouse changing jobs: all of these change what coverage your household needs. Make sure every person who should be covered is enrolled and nobody who should not be is still on the plan. Adding a newborn usually has its own deadline outside open enrollment, but open enrollment is the moment to get the rest of the household right. While you are at it, confirm your beneficiaries on any life insurance or supplemental policies are still correct, and update emergency contacts and your mailing address if you moved.
9. Check for new plan options
Employers change their plan lineups. A new PPO option might have appeared, or the HDHP might now come with a larger employer HSA contribution. On the marketplace, new insurers enter and leave state markets regularly. Do not assume this year’s menu matches last year’s. Read the whole list even if you expect to stay put.
10. Verify your subsidy or tax credit eligibility
If you buy through the marketplace, your premium tax credit depends on your estimated income for the coming year. Update your income estimate; underestimating means repaying part of the credit at tax time, and overestimating means paying more premium than necessary all year. Income changes like a raise, a job change, or a spouse’s new job all affect this.
11. Read the fine print on referrals and prior authorization
HMO-style plans require referrals for specialists, and many plans require prior authorization for procedures, imaging, and certain drugs. These rules tighten or loosen year to year. If you see specialists regularly or have a procedure planned, confirm the referral and authorization requirements before you commit to a plan that makes them harder.
12. Do not auto-renew blindly
Auto-renewal keeps you covered, which is good, but it also keeps you in a plan that may no longer fit. Treat auto-renewal as a fallback, not a decision. Even if you end up staying with the same plan, going through this checklist means you chose it deliberately rather than by inertia. The plans that reward inertia the least are the ones that raised premiums while shrinking networks.
After you enroll
Save your confirmation, note the plan’s effective date, and check that new insurance cards arrive before January. If you take regular prescriptions, confirm they transfer smoothly to the new plan year, especially if the formulary changed. And set a calendar reminder for next year’s open enrollment now, while you remember how much there was to check. Future you will appreciate it.
For a refresher on the terms you will see on every plan document, our guide to premiums, deductibles, and copays breaks down how the three work together on a real claim.
