Before You Enroll: Your Year-End Health Plan To-Do List
Peter Graham, M.D.
| 3 min read
Peter T. Graham, M.D., is the clinical director for ...
Key Takeaways
- Open enrollment is the ideal time to compare health plans and ensure coverage aligns with healthcare needs and budget goals.
- Looking beyond monthly premiums helps reveal the true cost of coverage, including deductibles, copayments and out-of-pocket expenses.
- Reviewing provider networks, prescription coverage and additional benefits can help maximize value and avoid unexpected healthcare costs.
- Changes to Marketplace rules, benefits and personal circumstances make it important to carefully evaluate coverage options each year.
Open enrollment is an opportunity to take a fresh look at health coverage before a new plan year begins. Instead of automatically renewing the same plan, reviewing current coverage and comparing available options can help ensure a health plan evolves with one’s healthcare needs and budget.
A little preparation before open enrollment can also make it easier to understand what a plan covers and what healthcare may cost throughout the year.
Where to start: Figuring out the total cost of coverage
The monthly premium is an important consideration, but it is only one part of the cost of health insurance. Before enrolling, review the plan’s deductible, copayments, coinsurance and out-of-pocket maximum.
Consider how much healthcare was used during the past year and whether that is likely to change. Someone expecting more doctor visits, prescriptions, a planned procedure or ongoing treatment may have different cost considerations than someone who doesn’t go to the doctor more than once or twice a year.
It is also important to review a plan’s provider network. Check whether preferred doctors, hospitals, specialists and pharmacies are included. Different types of plans – including HMOs, PPOs, EPOs and high-deductible health plans – can have different rules for accessing care and sharing costs.
Tips to look beyond the basics
Health insurance can include benefits that are easy to overlook when comparing plans. Review the preventive services included with the plan, as well as options such as virtual care, behavioral health services and prescription drug coverage.
Depending on the plan, there also may be programs or enhanced benefits designed to support healthier habits or help manage specific health needs. These can include tobacco cessation, weight management, condition-management programs and nutrition guidance and other resources.
Examining changes for 2027
The health insurance market dictates changes to premiums, deductibles, provider networks, covered services, prescription formularies and benefits from year to year.
Federal rules can change, too. For example, CMS has finalized changes affecting the 2027 Affordable Care Act Marketplace open enrollment period. For states using the federal Marketplace platform, the 2027 enrollment period is scheduled for Nov. 1 through Dec. 15, 2026. Other employers and coverage programs may have different enrollment periods.
That makes it important to review the information provided by an employer, insurer or Marketplace rather than assuming current coverage will remain unchanged.
Questions to ask before enrolling
Before hitting “submit” on a new coverage plan, here are questions to consider:
- Are preferred doctors, hospitals and specialists in this plan’s network?
- Approximately how much healthcare am I expected to need in 2027?
- Are there planned procedures, new prescriptions or ongoing treatments to consider?
- How do the deductible and out-of-pocket maximum compare with the monthly premium?
- Are important medications covered, and what will they cost?
- Have household circumstances changed, such as a marriage, divorce, new child or change in employment?
- Which preventive, virtual, behavioral health and wellness benefits are included?
- Are there health accounts or other programs that could help manage healthcare expenses?
Open enrollment is a chance to reassess healthcare needs and make sure coverage continues to align with the year ahead. Taking time to review the details before enrolling can help avoid surprises and make the most of the coverage available in 2027.
Peter Graham is the clinical director for the Blue Care Network. For more health tips and information, visit bcbsm.mibluedaily.com.
Photo credit: Getty Images
