Most people handle open enrolment by keeping what they had. That would be reasonable if plans stayed the same, and they do not — premiums change, deductibles change, networks drop providers, and formularies move medications between tiers. Re-electing without checking means accepting whatever changed.
The comparison takes an hour and it is one of the better-paid hours available.
This is general information, not insurance advice. Plan terms vary; read your specific documents.
What changed in 2026
- Cost sharing continued shifting to employees. Higher deductibles and out-of-pocket maximums remained the trend in employer plans.
- Network narrowing persisted. Plans with smaller networks and lower premiums grew, making provider verification more important.
- Comparison tools improved. More employers provided modelling tools estimating total cost based on expected usage.
- Formulary changes stayed frequent. Medications moving tiers or off formulary between years remained a common surprise.
Compare total cost, not premium
The premium is the visible number and the incomplete one. What matters is premium plus what you expect to pay out of pocket.
| Component |
Include |
| Annual premium |
Your share, times pay periods |
| Deductible |
The amount you pay before coverage begins |
| Copays and coinsurance |
Per visit and per prescription, times expected usage |
| Out-of-pocket maximum |
The worst-case ceiling |
| Employer account contribution |
Reduces net cost; frequently overlooked |
| Tax saving from a pre-tax account |
Reduces effective cost |
Estimate against your actual usage from last year. Count your visits, your prescriptions, and any procedures. Run each candidate plan against that pattern.
Then run the worst case. If something serious happens, what is your maximum exposure under each plan? That number is what insurance is actually for, and a plan with a low premium and a very high maximum is a different risk proposition from one with the reverse.
A high-deductible plan paired with a health savings account frequently wins for people with low usage, particularly with an employer contribution — the account mechanics are in FSA versus HSA.
Check the specifics
Verify your doctors are in network for the specific plan next year. Networks change annually and a provider in-network this year may not be next year. Confirm with the insurer rather than the directory, as described in in-network versus out-of-network.
Check your medications against next year's formulary. A drug moving to a higher tier or off formulary entirely changes your costs substantially, and it happens without individual notice.
Check whether any planned procedures are covered and what the cost share is.
Confirm dependent coverage rules if your situation changed.
Review the other elections at the same time. Life insurance, disability coverage, and pre-tax accounts are elected in the same window and receive less attention than they deserve. Disability coverage in particular is underweighted relative to the risk it addresses.
Deadlines and defaults
Open enrolment has a firm deadline, and missing it generally means keeping your current elections or having no coverage until the next period, absent a qualifying life event.
Know what happens by default. Some plans auto-renew your current election; some default to a specific plan; some default to no coverage. The default is not always what you would choose.
Qualifying life events — marriage, birth, job loss, loss of other coverage — open special enrolment periods outside the normal window, with their own deadlines that are typically short.
Common mistakes
- Auto-renewing without reviewing. Plans change even when you do not.
- Comparing premiums only. Total cost is premium plus expected out-of-pocket.
- Not checking the network for next year. Providers drop between years.
- Not checking the formulary. Medications move tiers without notice.
- Ignoring the out-of-pocket maximum. The number that matters in a bad year.
- Skipping the other elections. Disability coverage especially.
FAQ
How do I estimate my usage?
Use last year's actual claims — most insurers provide a summary. Adjust for anything you know is changing.
Is a high-deductible plan a bad idea?
Not inherently. Paired with a savings account and an employer contribution it frequently wins for low utilization. Model it against your usage.
What if I miss the deadline?
Generally you keep current elections or go without until the next period, absent a qualifying event.
Can I change mid-year?
Only with a qualifying life event, within a short window after it.
Where to go next
For pre-tax accounts, read FSA versus HSA. For network verification, in-network versus out-of-network, and for marketplace options, marketplace subsidy explained.