Benefits Enrollment Begins in a Few Weeks for Many - Consider These 5 Tips for Choosing a Health Insurance Plan

Benefits enrollment for many companies (as well as Affordable Care Act Marketplace health insurance plans) begins in November. You will typically need to enroll by December 15 for coverage that begins January 1 (but employers may have different deadlines so be sure to look for communication from HR).¹ For someone looking to change or add coverage, this offers a short window of time to decide on and select your health insurance plan. To avoid a hasty decision to meet this deadline, take some time now to review and prepare. Below we’ve rounded up a few tips for choosing the right health insurance plan for you and your family’s needs, and we remain available to assist clients with benefits enrollment decisions. 

Who Should Utilize Open Enrollment?

The Open Enrollment Period (or OEP) is for anyone looking to make a change to their health insurance coverage, whether through their workplace or the federal market. This could include looking for a cheaper plan with similar coverage, gaining coverage if you previously had none, or changing your coverage altogether to better meet your needs. Outside of this open enrollment period, you are typically only allowed to change your coverage if you have a qualifying life event (for example, family changes, job changes, or a loss of coverage – see here for a more complete list, but be aware that employer plans may sometimes have different rules).

Tip #1: Assess Your Current Costs 

When thinking about changing your health insurance plan, it’s important to reassess your healthcare-related expenses. Take a look at how much you’re currently paying per month for your plan as well as what sort of out-of-pocket expenses you paid over the past 12 months. 

These could include:

• Routine doctor’s visits
• Specialist visits
• Prescriptions
• Emergency room or urgent care visits

Unless you foresee any major changes in the coming year (such as pregnancy), this could be a helpful indicator when it comes to determining what type of coverage will be cost-effective and appropriate for you.

If you found your out-of-pocket expenses to be too high, now’s your opportunity to search for a plan with lower deductibles (although your monthly premiums will likely rise). To choose the optimal plan (or plans, if your household has access to multiple employers’ health insurance), you’ll want to consider not only premiums and deductibles, but also the out-of-pocket maximum, copays and coinsurance, HSA or FSA eligibility, prescription coverage, and so on.

Tip #2: Choose Your Marketplace

You may be able to gain coverage through several marketplaces, including:

• Your or your spouse’s workplace
• Federal marketplace
• Local or state marketplace
• Private exchange
• Directly through insurance providers

If you have the option to gain coverage through your employer, this will likely provide you with the lowest premiums (unless you can qualify for healthcare premium subsidies and tax credits due to your income). That’s because your employer may pay a portion of the premium, which tends to be lower anyway for group plans at large employers. Additionally, any premiums you pay in most cases will reduce your taxable income if paid through an employer compared to obtaining coverage on your own.

If your employer does not provide healthcare coverage (or you wish to look elsewhere for it), you can gain coverage through the federal or state marketplace. You’ll start at Healthcare.gov, which will then direct you to your state’s marketplace (if applicable). While premiums are likely to be higher and coverage networks may be limited, you may be eligible for premium tax credits to help offset the monthly cost.

Tip #3: Decipher Your Available Plan Types

There are four common types of health insurance plans you’ll come across when selecting coverage: HMO, PPO, POS, and EPO.

1. Health Maintenance Organization (HMO)

• Pros: HMOs tend to have lower monthly premium costs and out-of-pocket costs as compared to other plan types. 
• Cons: You’re typically limited to seeing providers only in your network, and these must be coordinated by your primary care provider (unless it’s an emergency). This gives you less overall flexibility, particularly if you travel and need care outside of your network for non-emergencies.

2. Preferred Provider Organization (PPO)

• Pros: PPOs offer the participant more freedom when it comes to choosing healthcare providers and specialists. You can see healthcare providers outside of your coverage network, although this will typically result in higher out-of-pocket costs. Additionally, you typically will not need a referral from your primary care provider to make appointments with specialists.
• Cons: Out-of-pocket costs and premiums tend to be higher for PPO plans, especially when compared to an HMO.

3. Point of Service Plan (POS)

• Pros: With a POS plan, you have the flexibility to visit out-of-network healthcare providers, but typically at a high out-of-pocket cost.
• Cons: Similar to an HMO, you will likely need a referral from your primary care provider to see a specialist or have a medical procedure done. Additionally, your primary doctor will coordinate your care for you.

4. Exclusive Provider Organization (EPO)

• Pros: An EPO will typically offer you lower out-of-pocket costs, and a referral is not needed to see specialists or have medical procedures done.
• Cons: You will be required to visit specialists within your network unless it is an emergency. An EPO will typically provide less flexibility and freedom when it comes to choosing care providers.

Tip #4:Consider an HSA-Eligible Plan

Regardless of the plan type above, some of the plans offered will allow you to contribute to a Health Savings Account (HSA). These accounts offer a triple tax benefit (tax-deductible contributions up to the family maximum of $8,550 for 2025, tax-free growth until withdrawn, and tax-free withdrawals for qualified medical expenses). We typically recommend investing these HSA contributions to allow for tax-free growth rather than spending it early on as costs are incurred. However, you can still withdraw from the HSA as needed if unexpected medical costs arise, and you can also reimburse yourself for medical expenses from prior years if you can provide documentation for those expenses (as long as the expenses were incurred after you began contributing to an HSA).

Not all high-deductible plans qualify so you want to make sure the plan you have selected is an HSA-eligible plan (typically without copays and having a high deductible that must be satisfied for most services other than preventative). Also, be aware that to participate in an HSA, you must not have any other health coverage (including if your spouse has a flexible savings account through their employer coverage).

If you don’t participate in an HSA-eligible plan, you can contribute up to $3,300 for 2025 to a flexible savings account (FSA). These accounts provide a tax deduction for any amount contributed, but unlike HSAs, FSAs generally have a “use it or lose it” provision and can’t be carried forward for future year’s spending (other than around $600).

Tip #5: Account For Your Current Providers

As shown above, every plan type either requires you to visit in-network providers or offers lower out-of-pocket costs for visiting an in-network specialist. If you already have preferred providers on your current plan, switching plans could jeopardize your ability to visit them in the future (or cost you more to do so). 

When comparing plans, make sure to check whether or not your current healthcare providers are in-network. If they are, you should have no problem continuing to see them as you did before. If they’re out-of-network, you’ll either have to find a new provider or prepare to pay more for every visit.

Picking the right health insurance plan for you and your family can feel daunting, confusing, and rushed. With some time left before open enrollment, do yourself a favor and create your plan of action now. Prepare now by determining what type of plan may be right for you, what coverage you know you’ll need, and what marketplace you’ll be buying from. When open enrollment hits, you’ll be more than ready to make a decision that’s right for your healthcare needs.