How to Choose a Health Insurance Plan During Open Enrollment

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While fall might mean cooling temperatures, changing leaves, and pumpkin spice lattes for many, for the Healthcare Hustlers it means Open Enrollment season! For those who need a quick recap, Open Enrollment is the time of year where you are eligible to change your health insurance plan (otherwise you have to wait for a "qualifying life event" to make changes to your plan).

It can be a confusing time of year, but have no fear, the Healthcare Hustlers are prepared. We’ve broken down some of our top tips to consider for open enrollment.

As a bonus, we created a downloadable plan calculator to give you a better idea of the true cost of each plan. Keep scrolling to download!

1. Estimate your expected healthcare utilization for the upcoming year. 

Think about the services you usually receive, and then think about any new services that you may need in the new plan year. This includes your primary care visits, specialist visits, urgent care visits, ER visits, prescriptions, and any other procedures. 

2. Review the plans to understand your coverage options.

Start with the big picture. Determine the following for each plan: 

  1. Annual Premium - The total annual cost of your bi-weekly contribution to your health coverage

  2. Deductible - The amount you owe for a service before insurance begins to pay a portion.

  3. Out-of-Pocket Maximum - The maximum amount you are responsible for paying each plan year. This usually is met if you have several procedures in one year. Once the out-of-pocket maximum is met, the insurance company will pay for 100% of the cost of medically necessary services received from in-network providers.

  4. Any Employer Contributions (other than premiums) - Some employers contribute money to HSA accounts. Be sure to factor in their contribution. 

Even with a rough estimate of your expected healthcare utilization, understanding these gets you close to the right plan. 

If you were to buy a plan and never use anything beyond preventive care, your only cost will be the annual premium. 

3. Calculate the cost of the 3 key scenarios for each plan. 

No Usage 

  • What if I don’t use ANY health services (other than preventive care)?

  • Calculation: Total Annual Cost of Premiums

Expected Usage 

  •  What if I use the services I expect based on my “expected healthcare utilization” planning from Step 1? 

  • Calculation: Total Annual Cost of Premiums + Cost of Care Applied to Benefits (Deductible, Co-insurance) 

Worst Case 

  •  What is the worst-case scenario if I fall extremely ill and need lots of care?

  • Calculation: Total Annual Cost of Premiums + Out of Pocket Maximum

Note: While this is less common, if your plan says that your deductible is not included in your out-of-pocket maximum, add the deductible as well. 

Want to skip all of this math? Check out the “Pros, Cons, and Best For” list in our article about understanding the different types of healthcare plans and download the OE Plan Calculator below.

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