Five key points to weigh before selecting a health insurance plan

Households buying coverage through state-run marketplaces or HealthCare.gov will have a chance to compare health insurance options during the upcoming open enrollment period.

The enrollment window starts at the beginning of November. People who want a new plan can sign up or switch coverage by mid-December for benefits that begin on Jan. 1, 2027. The regular enrollment period continues into mid-January, and those who enroll after the first deadline but before that final cutoff will see coverage take effect in February.

People with Medicare follow a different enrollment schedule that overlaps with marketplace sign-up periods, and many employer-based plans also open enrollment in the fall.

Mychal Winter, president of the National Association of Benefits and Insurance Professionals, said open enrollment can feel confusing as families sort through healthcare coverage choices.

He said the timing makes it especially important to have an insurance professional help guide the process, particularly as affordability remains a major concern.

Winter pointed to several factors households should keep in mind when comparing plans.

Look back at healthcare spending

Winter said one helpful step is to review what healthcare costs looked like over the past year or so.

He also recommended thinking about current medical needs and trying to anticipate what additional care may be needed going forward.

Compare changes in plan costs

Winter said premiums are generally expected to rise and that shoppers should compare what they paid before with what they may pay now.

He said previous rates are unlikely to stay the same because inflation, provider costs and labor expenses all tend to push prices higher.

He added that families should look at the plan from a budgeting perspective and decide whether it still fits their finances while covering their medical needs.

Premiums may differ from one year to the next, making budget review an important part of open enrollment.

Confirm that your doctors stay in network

Doctors, other healthcare professionals and hospitals can change their agreements with insurers from year to year, which means a provider that was covered before may no longer be in network.

Winter said it is wise to check every year whether a primary care doctor and other regular providers are still included in the plan.

He added that a preferred provider organization, or PPO, can give patients more freedom to choose doctors or specialists without a referral, though that flexibility can come with higher costs if they go out of network.

Weigh deductibles and out-of-pocket costs

Winter said shoppers should also examine deductibles, co-payments and other out-of-pocket expenses, including what it may cost to visit a primary care doctor or go to the hospital.

He noted that many people choose high-deductible plans to keep monthly premiums lower, but that approach only works if they can afford the deductible when care is needed.

Review health savings account choices

Some high-deductible plans on marketplace exchanges come with a health savings account, or HSA, that can help households save.

Money put into an HSA is tax-free, can grow tax-free through investment, and can be withdrawn tax-free for qualified medical expenses. Balances also roll over from year to year, making the account useful for longer-term savings.

Winter said HSA funds can also help cover deductibles and other healthcare costs that come up.