Picking a Health Plan at Open Enrollment

The story: Ana and Marcus pick a plan

Ana and Marcus compare two health plans on paper, writing totals for a healthy year and a bad year.

1. Narrator: It’s open enrollment. Ana’s job offers two health plans for the family.
2. Marcus: Plan A has the lowest premium. Let’s just take that one.
3. Ana: But its deductible is much higher. What if one of us ends up in the hospital?
4. Narrator: They add up each plan for a healthy year, a normal year and a bad year: premiums plus what they’d pay for care.
5. Narrator: Plan A costs less in a healthy year. Plan B costs less in a bad year, because its out-of-pocket maximum is lower.
6. Ana: And our kids’ doctor is in both networks. Now we can choose with our eyes open.
7. Narrator: Compare the worst year, not just the premium.

What you’ll learn

1. The words on every plan

   The premium is what you pay each month to have coverage. The deductible is what you pay for care before the plan starts sharing costs. The out-of-pocket maximum is the most you’d pay for covered care in a year. The network is the doctors and hospitals the plan works with.

2. Test a healthy, a normal and a bad year

   For each plan, add a year of premiums to what you’d pay for care. Do it for a healthy year, a normal year and a bad year. The bad year uses the out-of-pocket maximum. A low premium can turn into the most expensive plan in a bad year.

   Example: Plan A costs $3,000 in a healthy year and $9,400 in a bad one. Plan B costs $5,550 and $8,900.

3. Doctors, HSAs and two-job households

   Check that your doctors are in the network. Some high-deductible plans can be paired with an HSA, a tax-advantaged health savings account. A spouse’s general health FSA can block that. Couples with two job plans compare the family total for each setup.

4. Life events reopen the window

   Outside open enrollment, a big life event like a birth, a marriage or losing other coverage opens a short window to change plans. The limits for HSA-eligible plans and HSAs change every year and are on the fact cards.

Key words

premium

what you pay each month to have coverage

deductible

what you pay for care before the plan starts sharing costs

out-of-pocket maximum

the most you’d pay for covered care in a year

network

the doctors and hospitals a plan works with

Common questions

What are copays and coinsurance?

A copay is a set price for a visit or a prescription. Coinsurance is your share of a bill as a percent, such as 20%, after the deductible.

Can I pick a plan outside open enrollment?

Usually only after a big life event, like a birth, a marriage or losing other coverage. The window is short, so act quickly.

Remember this

Compare the worst year, not just the premium.

Try it: Run the three-year test

1. At open enrollment, list each plan’s premium, deductible and out-of-pocket maximum.
2. Add up a healthy, a normal and a bad year for each plan.
3. Check that your doctors are in the network.
4. Add “check health plans at open enrollment” to your yearly check-up list.

No account needed: your plan papers and a sheet of paper.

Live facts

Numbers that change over time, with when they were last checked and where they come from.

• HSA limit, self-only coverage

  $4,400

  Yearly HSA limit with self-only high-deductible coverage

  As of 2026

  Source: IRS.gov(opens in a new tab)

• HSA limit, family coverage

  $8,750

  Yearly HSA limit with family high-deductible coverage

  As of 2026

  Source: IRS.gov(opens in a new tab)

• Out-of-pocket maximum caps

  Source: HealthCare.gov(opens in a new tab)

• Which plans are HSA-eligible

  Source: IRS.gov (Publication 969)(opens in a new tab)

• Marketplace enrollment dates and life events

  Source: HealthCare.gov(opens in a new tab)