How to Choose a Health Plan During Open Enrollment

Pick the right health insurance plan by comparing total costs, networks, and coverage for your actual medical needs.

1. Calculate your total potential cost for each plan. Add the annual premium to the out-of-pocket maximum for each plan option. This gives you the worst-case scenario cost if you hit your spending limit. For example, a plan with $2,400 in annual premiums and a $3,000 out-of-pocket max costs $5,400 total if you have a major medical event.
2. Check if your doctors and hospitals are in-network. Call your primary care doctor, specialists, and preferred hospital to confirm they accept each plan you're considering. Don't rely on online directories — they're often outdated. Out-of-network care can cost 3-5 times more than in-network care.
3. Verify your medications are covered. Look up each plan's formulary (drug coverage list) to see if your prescriptions are covered and at what tier. A drug on tier 1 might cost $10 per month, while the same drug on tier 3 could cost $75 per month.
4. Match the plan type to your medical usage. If you rarely see doctors, choose a high-deductible plan with lower premiums. If you have chronic conditions or take multiple medications, pay higher premiums for lower deductibles and copays. The break-even point is typically around $3,000-$4,000 in annual medical spending.
5. Consider HSA eligibility if you qualify. High-deductible health plans with deductibles of at least $1,650 for individuals or $3,300 for families qualify for Health Savings Accounts. HSAs offer triple tax benefits and can serve as retirement accounts after age 65.