Keeping the same health plan may feel like the easiest choice during open enrollment. The name is familiar, the insurance card is already in your wallet and renewing may require little or no action.
But familiar does not necessarily mean unchanged.
Your premium, deductible, provider network and prescription coverage may be different next year. Your health, income, family and expectations may have changed too.
Before allowing your coverage to renew, ask these seven questions.
1. Did the premium, deductible or out-of-pocket maximum change?
The monthly premium is the most visible cost, but it is only one part of what you may spend.
Compare your current and upcoming plan documents for changes to:
- Monthly premiums
- Annual deductibles
- Copayments
- Coinsurance
- Prescription costs
- Out-of-pocket maximums
A plan with a lower premium may require you to pay considerably more when you receive care. A higher-premium plan could provide better overall value if you expect regular appointments, tests, procedures or costly prescriptions.
Also remember that premiums generally do not count toward the out-of-pocket maximum. Out-of-network care and services the plan does not cover may not count either.
The better comparison is not simply, “Which plan costs less each month?”
Ask, “What could each plan cost during the kind of year I am likely to have?”
2. Are your doctors and hospitals still in-network?
Provider networks can change from one year to the next, even when the plan name remains the same.
Do not rely solely on what was covered this year. Confirm the participation of:
- Your primary care physician
- Specialists you see regularly
- Your preferred hospital
- Nearby urgent care centers
- Laboratories and imaging facilities
- Any provider involved in planned treatment
Use the plan’s current online directory, but consider calling the provider as well. Ask whether the provider will participate in the specific plan and network you are considering for the upcoming year.
A carrier’s name is not enough. The same insurance company may offer several plans with different networks.
3. Are your prescriptions still covered at the same cost?
Health plans maintain formularies that determine which medications are covered and how much members pay.
A prescription may:
- Move to a different cost tier
- Require prior authorization
- Be subject to quantity limits
- Require step therapy
- Be removed from the formulary
- Cost more at a nonpreferred pharmacy
Check every medication you take regularly, including its exact name and dosage. Then confirm whether your pharmacy remains preferred under the plan.
If a medication is not covered favorably, ask whether another plan treats it differently. You can also speak with your doctor about covered alternatives, but that conversation should happen before the medication is needed.
4. Has your income or household changed?
This is especially important for people purchasing coverage through the Health Insurance Marketplace.
Marketplace savings are based on your expected household income and household information for the year of coverage. A marriage, divorce, birth, adoption, job change or change in income may affect the assistance for which you qualify.
Update your application rather than simply accepting the previous information. If the Marketplace uses an outdated income estimate, you could receive too little assistance during the year or potentially have to repay part of an advance premium tax credit when filing your federal tax return.
Employer-plan costs may also change when a spouse or child is added or removed. Review the cost for the coverage level you actually need, not only the employee-only rate.
Learn more about renewing or changing Marketplace coverage at HealthCare.gov
5. Are you expecting different healthcare needs next year?
No one can predict every illness or injury, but some healthcare needs are foreseeable.
Consider whether anyone covered by the plan expects:
- Surgery or another procedure
- Pregnancy or childbirth
- Regular specialist visits
- Physical therapy
- Behavioral healthcare
- Diagnostic testing or imaging
- Expensive prescriptions
- Treatment for a chronic condition
Then look beyond the deductible. Determine how the plan covers the specific services you expect to use.
One plan may offer office visits before the deductible while another requires you to meet the deductible first. Hospital care, imaging, therapy and specialty medications may each have different cost-sharing rules.
Your recent healthcare use is not a perfect forecast, but it is a better starting point than choosing a plan based only on its premium.
6. Could another plan provide better overall value?
The cheapest plan is not automatically the best value, and the most expensive plan is not automatically the most comprehensive.
Compare each option across the same set of factors:
- Annual premium
- Deductible
- Out-of-pocket maximum
- Provider network
- Prescription coverage
- Copayments and coinsurance
- Benefits available before the deductible
- Expected healthcare use
You should also consider your ability to absorb an unexpected expense.
A high-deductible plan may make sense for someone who uses little care and has sufficient emergency savings. Someone managing a chronic condition or anticipating treatment may prefer to pay more each month for more predictable costs when receiving care.
The right plan is the one that offers a workable balance between monthly affordability, expected healthcare needs and financial risk.
7. Are you reviewing the right type of coverage?
“Open enrollment” does not refer to one universal enrollment period.
Employer coverage
Employers establish their own enrollment dates and plan choices. Review the materials provided by your employer and complete any required election by its deadline.
Marketplace coverage
For 2027 coverage through HealthCare.gov, Open Enrollment runs from November 1 through January 15. Enroll or change plans by December 15 for coverage beginning January 1. State-run Marketplaces may use different deadlines.
Review Marketplace dates at HealthCare.gov
Medicare
Medicare Open Enrollment runs from October 15 through December 7. During this period, eligible beneficiaries can review and change Medicare Advantage or prescription drug coverage for the following year.
Medicare plans can change their costs, benefits, provider networks, pharmacies and drug coverage annually. Review the Annual Notice of Change and Evidence of Coverage even if you are satisfied with your current plan.
Learn about Medicare Open Enrollment at Medicare.gov
Medicare plans are not sold through the Health Insurance Marketplace. If you are unsure which enrollment rules apply to you, ask for help before making a change.
Do not renew on familiarity alone
Keeping your current plan may ultimately be the right decision. The goal is not to change coverage simply because other options exist.
The goal is to make an informed decision.
Your health plan should still fit:
- The care you expect to use
- The doctors you want to keep
- The prescriptions you take
- The premium you can afford
- The financial risk you can manage
The easiest plan to renew is not necessarily the best plan to keep.
Let’s compare your 2027 coverage
Insureous can help you compare premiums, deductibles, provider networks, prescription coverage and out-of-pocket costs across your available options.
