Open Enrollment is a valuable time to reassess your health insurance plan. Whether your health needs have changed or you’re seeking better coverage options, switching plans during this period can lead to significant benefits. Here’s a guide on what to consider when deciding to change your health insurance plan and how to navigate the process smoothly:

1. Why Consider Switching Plans

You may want to consider changing plans if any of the following situations apply to you:

• Premium Increases: If your current plan’s premium has risen, consider exploring other plans to find one that fits your budget.
• New Health Needs: Changes in health needs, like planned surgeries, starting a family, or managing a chronic condition, may mean your current plan no longer offers the best fit.
• Coverage Changes: If your plan’s benefits have changed—such as the loss of a preferred provider or reductions in prescription coverage—this might be a good time to look for a plan that better meets your needs.

What to consider when deciding on a new plan:

2. Review Key Plan Features

When selecting a health insurance plan, carefully evaluate these critical factors:

• Premiums: Your monthly payment for coverage. Lower premiums often mean higher deductibles, so find a balance that aligns with your budget and expected healthcare usage.
• Deductibles: The amount you pay out-of-pocket before insurance coverage begins. Low deductibles are beneficial if you anticipate frequent doctor visits.
• Copays/Coinsurance: Fixed fees or percentages you pay for each service. These costs can add up, so compare copays for services you use regularly.
• Out-of-Pocket Maximum: The annual limit on your out-of-pocket medical expenses. This provides financial protection in case of unexpected high-cost events like surgeries.

Most people will focus on monthly premium only, believing that this is the best way to determine savings. It makes sense to assume this because the premium is a monthly payment, so it is foremost in the consumer’s mind as the cost of their insurance. However, a more balanced and cost-effective plan will also keep other potential expenses in mind. ‍

3. Check Provider Networks

Each plan has a network of healthcare providers who accept the insurance, usually at lower rates than out-of-network providers. Make sure your preferred doctors, specialists, or facilities are covered by any new plan you’re considering.

If continuity of care is important, ensure your doctors are in-network. For families, verify coverage for each family member’s preferred providers.

4. Review Prescription Drug Coverage

Prescription coverage varies widely, especially for brand-name and specialty drugs. If you rely on specific medications, confirm they’re covered affordably under any plan you’re considering.

Review the formulary (list of covered drugs) for each plan. Many plans use tiered coverage, where generics are cheaper than brand-name drugs.

5. Assess Your Health Needs for the Upcoming Year

Predicting your healthcare needs for the coming year can help you choose a plan that provides the right balance of cost and coverage. If you anticipate needing more care than usual, a plan with lower out-of-pocket costs might be more economical, even if the premium is higher.

Think about any planned surgeries, specialist visits, or family additions (like a baby) that might impact your healthcare needs. 

6. Know the Deadlines and Process for Changing Plans

Open Enrollment generally runs from early November to mid-December, but specific dates vary by state. During this period, you can change your plan through your employer, the ACA marketplace, or your insurer’s platform. Once you select a new plan, coverage typically begins on January 1 of the following year. If you miss Open Enrollment, you’ll need a qualifying life event to make changes outside this period.

Changing health insurance plans during Open Enrollment can help you find better coverage that fits your health needs and budget. By reviewing plan options, understanding key terms, and evaluating your upcoming healthcare requirements, you can confidently switch plans and ensure a smooth transition to your new coverage. Let HealthBird guide you through the process with tools and resources to simplify your health insurance decisions.