Open Enrollment: A Step-by-Step Walkthrough for Picking a Health Plan

Open enrollment dates vary by coverage type. For job-based coverage, your employer sets the window, typically in the fall. For Marketplace plans through healthcare.gov or a state exchange, the federal window generally runs from November 1 through January 15, though some states extend or shift these dates. Medicare's Annual Enrollment Period runs October 15 through December 7 each year.

Write your deadline on a calendar. Missing it means staying on your current plan for another year unless a qualifying life event triggers a Special Enrollment Period.

Pull your Explanation of Benefits statements from the past 12 months. Add up what you paid in premiums, deductibles, copays, and coinsurance. This total, not just the monthly premium, is your real baseline. If you rarely used medical services, a lower-premium, higher-deductible plan may cost less overall. If you had several doctor visits, specialist referrals, or filled multiple prescriptions, a plan with richer benefits and a higher premium may have saved you money.

Think through any anticipated changes: a planned surgery, a new specialist, a pregnancy, or a child aging off your plan. Write down every prescription you take regularly. These specifics will determine which plan categories make sense for you and which networks you cannot afford to leave.

Health plans generally fall into a few network and cost-sharing structures. An HMO (Health Maintenance Organization) requires you to use in-network providers and usually needs a primary care referral to see a specialist. A PPO (Preferred Provider Organization) gives you more flexibility to see out-of-network providers, typically at higher cost. An EPO (Exclusive Provider Organization) limits you to the network but usually skips referral requirements. An HDHP (High-Deductible Health Plan) has a higher deductible in exchange for a lower premium and eligibility to open an HSA.

For each plan you consider, note the monthly premium, deductible, copay or coinsurance for office visits and specialist care, and the out-of-pocket maximum (the most you would pay in a calendar year before the plan covers 100 percent).

Look up each plan's provider directory and confirm your primary care doctor, any specialists you see regularly, and your preferred hospital are listed as in-network. Then open the plan's drug formulary and locate each medication you take. Formularies group drugs into tiers, and your cost varies significantly by tier. A medication that costs $15 per month on your current plan could cost $80 or more on a new one if it sits in a higher tier.

If you are enrolling through the federal Marketplace or a state exchange, your household income relative to the federal poverty level determines whether you qualify for premium tax credits (subsidies) that reduce your monthly cost, or for cost-sharing reductions that lower your deductibles and copays. Enter your income on the Marketplace application to see what you qualify for before comparing plan prices. Medicaid and the Children's Health Insurance Program (CHIP) are also available year-round for households that meet income thresholds.

For each plan you are seriously considering, estimate a realistic annual cost. Multiply the monthly premium by 12, then add your expected out-of-pocket spending based on typical use. Run a best-case scenario (minimal care) and a worst-case scenario (hitting the out-of-pocket maximum). The plan with the lowest premium is not always the least expensive when you account for how often you actually use care.

If you are weighing a job change or thinking about switching plans, the checklist for switching health plans can help you avoid common gaps in coverage.

Once you have chosen a plan, complete enrollment through your employer's portal, healthcare.gov, or your state Marketplace. Print or save your confirmation and enrollment ID. Keep a copy of the plan's Summary of Benefits and Coverage for reference throughout the year.