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American households will have the opportunity to review their health coverage in November amid the upcoming open enrollment window for those purchasing health insurance through state marketplaces or federal exchanges on 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 plans so that their coverage takes effect on Jan. 1, 2027. The standard open enrollment period ends on Jan. 15 and coverage will take effect on Feb. 1 for enrollees who sign up after the deadline but before that date begins.
Americans covered through Medicare have a separate open enrollment period that overlaps with the marketplace enrollment period, while many employer-sponsored insurance plans 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 consider health coverage options.
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The open enrollment period begins Nov. 1 for households using the state-based marketplace and HealthCare.gov to purchase health insurance. (Matt McClain/The Washington Post via Getty Images)
Winter added that “the fact that we are coming up in the middle of the midterm elections and health care is at the forefront of all our minds, especially from the point of view of affordability, it is very important to make sure that you have an insurance professional to help you navigate through the maze.
They offer several aspects of the open enrollment process that households should consider when evaluating a plan.
Review and plan your healthcare spending
“One of the things you should do is look back to see what your health care expenses were in the last 12 months,” Winter said.
He adds that it can be useful to review “what your health requirements and needs are, and then, if you can, try and think about how you can anticipate other needs.”
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Evaluate plan cost changes
Winter noted that health insurance premiums will generally increase this year and households should consider last year’s premiums with the possibility of an increase.
“The rates you had the year before probably won’t be the same,” he said. “They’re going to grow because of what’s happening right now with inflation, health care costs from a provider standpoint, just the cost of care and the overall workforce is going to increase a little bit.”
“You have to look at it from a budgeting point of view to see if the plan you’re on beforehand fits your financial budget and expenses, as well as helps you make sure you’re covered for your health needs,” Winter said.
Health insurance plans may change premiums from the previous year as households consider their budgets when opening enrollment. (Getty Images)
Make sure your doctor is in network
Doctors, healthcare professionals and hospital networks can change their contractual relationships with health insurance plans from year to year, which may mean your doctor is no longer in network for your plan next year.
“Sometimes they have a little bit of a standoff for what the rates are going to be, what the costs are going to be, and they can determine who is going to go out of the network,” Winter said. “Every year it’s a good idea to check that your primary care doctor and the doctor you’re seeing is still in network.”
He adds that enrolling in a plan from a preferred provider organization (PPO) can allow you to choose a doctor or specialist without a referral, although having that flexibility can be expensive to see an out-of-network provider.
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Doctors and specialists can change networks every year, so consumers should check to see if the doctor is still in the plan’s network or if they need to change. (Philips)
Consider deductibles and out-of-pocket thresholds
Winter said that out-of-pocket costs, along with co-pays for potential primary care doctor or hospital visits, should be looked at to determine the cost of using a given health plan.
“Many times what people will do is that they will go with a high deductible plan so that the monthly premium goes down. It’s a good strategy if possible, but on the back side, you have to anticipate if you can afford that deductible,” said Winter.
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Check out HSA options
Some high-deductible health insurance plans offered on the marketplace include a health savings account (HSA) that can help households save.
Funds can be contributed to the HSA on a tax-free basis, invested to grow on a tax-free basis, and then available for withdrawal tax-free for qualified withdrawals. HSA balances also roll over each year without expiring, allowing for long-term savings.
Winter added that the funds in the HSA can be used to pay deductibles and other health care expenses.