What Should You Review Before Health Insurance Open Enrollment Ends?
Open enrollment tends to arrive at a busy time of year, and it’s tempting to just re-select the same plan without a second look — but a few details are worth checking before the window closes.
The short answer
Before open enrollment ends, it’s worth reviewing whether your preferred doctors and facilities are still in-network, whether any regular medications are still on the plan’s drug formulary at the same cost tier, and whether your expected healthcare use for the coming year still matches the plan design you’re about to keep or choose. Plans can change these details from one year to the next even when the plan name stays the same, so re-enrolling without checking can mean an unwelcome surprise later.
Why networks are worth rechecking every year
Provider networks change from year to year, sometimes because a hospital system and an insurer renegotiate a contract, and sometimes for reasons that have nothing to do with the plan itself. A doctor or facility that was in-network last year isn’t necessarily still in-network this year, even under an identical-sounding plan. Confirming network status directly, rather than assuming it carried over, avoids the cost gap that comes with out-of-network care.
Why a drug formulary needs a second look too
The same logic applies to prescription coverage. A plan’s list of covered medications, and the cost tier a specific drug falls into, can shift between plan years even when the plan’s overall structure looks unchanged. Someone taking a regular medication is generally better off confirming its formulary status and cost before the enrollment window closes, rather than discovering a change at the pharmacy counter later.
Matching the plan to expected use, not last year’s use
A plan that made sense last year might not be the best fit if circumstances have changed — a new diagnosis, a planned procedure, a growing family, or simply a year of unusually low healthcare use. Comparing a high-deductible plan against a lower-deductible option, or weighing HMO versus PPO structures, generally comes down to how much predictable versus unpredictable care is expected in the coming year, which can shift from one year to the next.
Comparing cost structure, not just premium
The lowest premium isn’t necessarily the lowest total cost. Reviewing the deductible, out-of-pocket maximum, and typical copay or coinsurance amounts alongside the premium gives a fuller picture of what a plan year might actually cost under different scenarios, from a light usage year to one involving a major medical event.
What to weigh
- Provider network status. Confirm regular doctors and facilities are still covered before assuming continuity.
- Formulary and drug tier changes. A medication’s cost can shift even if the plan name doesn’t.
- Expected usage for the coming year. Match the plan design to what’s actually likely to happen, not just to what happened last year.
- Total cost picture, not just the premium. Deductible and out-of-pocket maximum shape what a high-usage year would actually cost.
The bottom line
Open enrollment rewards a few minutes of comparison over defaulting to whatever was chosen last year, since networks, formularies, and even plan designs can shift quietly between years. A short review before the deadline is generally the difference between a plan that fits and one that simply carried over by habit.