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U.S. households will have the opportunity to review their health coverage in November as part of the upcoming open enrollment window for those who purchase their health insurance on state marketplaces or the federal exchange at Healthcare.gov.
The open enrollment period begins Sunday, Nov. 1, and those who want to enroll in a new plan have until Dec. 15 to enroll or change their plan so that their coverage takes effect Jan. 1, 2027. The standard open enrollment period ends Jan. 15, and coverage would take effect Feb. 1 for enrollees who enroll after the original deadline but before that date.
Americans covered by Medicare have a separate open enrollment period that overlaps with marketplace enrollment periods, while many employer-sponsored insurance plans have open enrollment windows around October and November.
Mychal Winter, president of the National Association of Benefits and Insurance Professionals (NABIP), told FOX Business that “open enrollment can be overwhelming” as households evaluate their health coverage options.
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The open enrollment period begins November 1 for households using the public marketplaces and HealthCare.gov to purchase health insurance. (Matt McClain/The Washington Post via Getty Images)
Winter added that “with this coming right in the middle of the midterm elections and health care being at the forefront of everyone’s minds, especially from an affordability standpoint, it’s vitally important to make sure you have an insurance professional to help you navigate the maze.”
He outlined several aspects of the open enrollment process that households should consider when evaluating their plans.
Review and plan healthcare expenses
“One of the things you need to do is take a look back to see what your health care costs have been over the last 12 months or so,” Winter said.
He added that it can be helpful to look at “what your health care needs and requirements are, and then, if you can, try to figure out in the future how you can anticipate what other needs might be.”
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Evaluate plan cost changes
Winter noted that health insurance premiums are generally expected to increase this year and that households should evaluate last year’s premiums against a possible increase.
“The rates you had the year before probably won’t be the same,” he said. “They’re going to go up because of what’s happening now with inflation, the cost of health care from a provider perspective, just the overall cost of care and labor is going to drive it up a little bit.”
“You need to look at it from a budgetary perspective to see if the plan you had before would fit your financial budget and your expenses, while still helping you make sure you’re covered for your health care needs,” Winter said.
Health insurance plans may have changed their premiums from the previous year as households consider their budgets during open enrollment. (Getty Images)
Check if your doctors are in network
Physicians, healthcare professionals and hospital networks may change their contractual relationships with health insurance companies from year to year, which could result in your doctor no longer being in network for your insurance in the coming year.
“Sometimes they have a little bit of an impasse on rates and costs, and they may decide to go off-grid,” Winter said. “Every year, it is a good idea to check whether your primary care doctor and the doctors you see are still in network.”
He added that enrolling in a plan with a preferred provider organization (PPO) can allow you to choose your doctor or specialist without a referral, although this flexibility may cost more to see an out-of-network provider.
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Doctors and specialists can change networks from year to year. So consumers should check to see if their doctor is still in their plan’s network or if they need to change. (Philips)
Consider deductibles and spending thresholds
Winter said out-of-pocket costs, as well as things like co-pays for visiting your primary care doctor or potential hospitals, should be looked at to determine how much it may cost to use a given health care plan.
“Often people opt for a high-deductible plan to keep monthly premiums low. It’s a good strategy if it can work, but on the other hand, you have to anticipate whether you can afford that deductible,” Winter said.
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Review HSA Options
Some high-deductible health insurance plans offered on the exchanges include a health savings account (HSA) that can help households save.
Funds can be contributed to an HSA tax-free, invested to grow tax-free, and then can be withdrawn tax-free for qualified withdrawals. HSA balances also roll over from year to year without expiration, so they can help increase savings in the long run.
Winter added that these funds in an HSA can be used to help pay a deductible and other related healthcare expenses.
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