American households will have the opportunity to review their healthcare coverage in November amid the upcoming open enrollment window for those who buy their health insurance through state-based marketplaces or the federal exchange on Healthcare.gov.
The open enrollment period begins on Sunday, Nov. 1, and those looking to sign up for a new plan have until Dec. 15 to enroll or change their plan to have their coverage take effect on Jan. 1, 2027. The standard open enrollment period ends on Jan. 15 and coverage would take effect on Feb. 1 for enrollees who sign up after the initial deadline but before that date.
Americans who are covered through Medicare have a separate open enrollment period that overlaps with the 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 weigh their healthcare coverage options.
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Winter added that “the fact that it’s coming right in the middle of midterm elections and healthcare is on the forefront of everybody’s mind, especially from an affordability standpoint, it is vitally important to make sure you have an insurance professional to help you navigate through the maze.”
He offered several aspects of the open enrollment process that households should consider as they evaluate plans.
Review and planning healthcare spending
“One of the things you kind of have to do is take a look back to see what your healthcare expenditures consisted of the past 12 months or so,” Winter said.
He added that it can be helpful to review “what your healthcare requirements and needs are, and then, if you can, try and figure going forward how you may anticipate what some other needs may be.”
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Evaluate plan cost changes
Winter noted that health insurance premiums are generally expected to rise this year and that households should weigh last year’s premiums against a possible increase.
“The rates that you had the year before are probably not going to be the same,” he said. “They’re going to grow because of what’s happening right now with inflation, the cost of healthcare from a provider standpoint, just the overall care and labor cost is going to make it increase a little bit.”
“You’ve got to look at it from a budgeting standpoint to see if the plan that you had before would fit within your financial budget and your expenditures, along with helping you make sure that you’re covered for your healthcare needs,” Winter said.
Check whether your doctors are in-network
Doctors, healthcare professionals and hospital networks may change their contractual relationships with health insurance plans from year to year, which could mean that your doctor is no longer in-network for your plan in the year ahead.
“Sometimes they have a little bit of a standoff as to what the rates are going to be, what the costs are going to be, and they may determine that they’re going to move out of network,” Winter said. “Every year it is good to check to see if your primary care physician and the doctors you see are still in-network.”
He added that enrolling in a plan from a preferred provider organization (PPO) can allow you to choose your doctor or specialist without a referral, though having that flexibility may cost more to see an out-of-network provider.
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Consider deductibles and out-of-pocket thresholds
Winter said that out-of-pocket costs, along with things like co-payments for visiting your primary care physician or potential hospitals, should be reviewed to determine how much it may cost to use a given healthcare plan.
“A lot of times what people will do is they will go with a high deductible plan to keep the monthly premiums down. That’s a good strategy if it can work, but on the back side of it, you’ve got to anticipate if you can afford that deductible,” Winter said.
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Review HSA options
Some high deductible health insurance plans offered on the marketplace exchanges include a health savings account (HSA) that can help households save.
Funds may be contributed to an HSA on a tax-free basis, invested to grow on a tax-free basis, and then are available to be withdrawn tax-free for qualified withdrawals. HSA balances also roll over year-to-year without expiration, so they can help augment long-term savings.
Winter added that those funds in an HSA can be used to help pay for a deductible and other healthcare expenses that arise.
