Health
A practical checklist for health plan open enrollment
The marketplace window is short, employer windows are shorter, and last year’s plan is not automatically the right plan this year.
Open enrollment is the stretch of weeks when most Americans can start or change major medical coverage without a special reason. On the federal marketplace that period has commonly run from November 1 through January 15, with a mid-December deadline if you want coverage to begin January 1. State exchanges can set different dates. An employer plan follows the company’s own calendar, often two or three weeks in the fall. Missing the window usually means waiting until the next year unless you qualify for a special enrollment period, such as a loss of other coverage, a move, a marriage, or the birth of a child.
Start with how you actually use care
Write down the doctors you intend to keep, the prescriptions you refill, and whether anyone on the policy expects surgery or ongoing therapy. Then compare plans on four numbers, not on the monthly premium alone: the deductible, the copay or coinsurance after the deductible, the out-of-pocket maximum, and the cost of your specific drugs. A bronze plan can look inexpensive until a hospital stay. A gold plan can look expensive until you add up monthly prescriptions.
Networks and formularies change
A plan can keep its name and still drop a hospital or move a drug to a higher tier. Open last year’s explanation of benefits and this year’s summary side by side. If a medication is excluded, ask the plan about an exception before you enroll, not after the first denied refill.
Marketplace savings are income-based
Premium tax credits on the marketplace depend on household size and estimated income for the coverage year. Estimate honestly. If income comes in higher than you projected, you may have to repay some of the credit at tax time. If it comes in lower, you may be due more. Employer coverage that meets the affordability test generally blocks marketplace credits, even if you would prefer a marketplace plan.
This is a planning checklist, not a determination of what you qualify for. Use HealthCare.gov or your state exchange, and read the plan documents before you pay the first premium.