How to Choose a Health Insurance Plan During Open Enrollment

Picking a plan on HealthCare.gov or at work? Compare these six things — not just the monthly price — to avoid paying more than you need to.

Open enrollment is the yearly window when you can sign up for health insurance or switch plans. It's tempting to pick the plan with the lowest monthly premium and move on, but that choice can cost you thousands of dollars if you end up needing care. Here's how to compare plans the smart way.

Where Americans get coverage

• Through an employer: Most working-age Americans get insurance through a job. Your employer runs its own open enrollment period, usually in the fall.
• The Health Insurance Marketplace: If you don't have job-based coverage, you can shop at HealthCare.gov or your state's own marketplace website. Open enrollment for HealthCare.gov plans usually begins November 1. Deadlines have changed in recent years and some states run their own marketplaces with different dates, so check the official site for this year's exact dates.
• Medicaid and CHIP: Free or low-cost coverage for people with limited income, some families and children. You can apply any time of year.
• Medicare: For people 65 and older and some people with disabilities, with its own enrollment periods.

Missed open enrollment?

Certain life events — such as losing other coverage, getting married, having a baby or moving — can qualify you for a Special Enrollment Period. On the Marketplace, you typically have 60 days from the event to enroll.

Six things to compare

1. Total yearly cost, not just the premium

Add up 12 months of premiums, then think about what you'd pay if you needed care: the deductible, copays, coinsurance and out-of-pocket maximum. A low-premium plan with a high deductible can be the cheapest if you're healthy — and the most expensive if you're not. (Not sure what these words mean? Read our guide to health insurance terms.)

2. Your doctors and hospitals

Check that your current doctors, specialists and preferred hospital are in network for each plan you're considering. Networks can change from year to year, even with the same insurer, so check again every open enrollment.

3. Your prescriptions

Look up each medicine you take in the plan's formulary (drug list). Note the tier and the cost. A plan that doesn't cover an expensive medicine you need can quickly erase any premium savings.

4. Plan type

HMOs and EPOs usually cost less but limit you to the network; PPOs cost more but give you more freedom to see out-of-network providers. If you travel often or have family in other states, consider how the plan handles care away from home.

5. Metal level (on the Marketplace)

Marketplace plans are grouped by how costs are split between you and the plan, on average:

• Bronze: the plan pays about 60% — lowest premiums, highest costs when you get care.
• Silver: about 70%.
• Gold: about 80%.
• Platinum: about 90% — highest premiums, lowest costs when you get care.

Metal levels say nothing about the quality of care — only how costs are shared.

6. Savings you may qualify for

Depending on your household income and size, you may qualify for a premium tax credit that lowers your monthly Marketplace premium. People with lower incomes who choose a Silver plan may also qualify for cost-sharing reductions, which lower deductibles and copays. The size of these subsidies has changed in recent years, so enter your income estimate on HealthCare.gov to see your actual prices. Update the Marketplace if your income changes during the year to avoid owing money at tax time.

A simple way to decide

1. List your doctors, medicines and expected care for next year.
2. Narrow to plans that include your doctors and medicines.
3. For each, estimate a "low-use" year (premiums plus a few visits) and a "bad" year (premiums plus the out-of-pocket maximum).
4. Choose the plan whose costs you're most comfortable with in both scenarios.

Don't forget to review every year

Even if you like your plan, premiums, networks and drug lists change annually. If you're on the Marketplace and do nothing, you may be automatically re-enrolled in the same or a similar plan — which may no longer be your best deal. Spend an hour comparing each open enrollment.

This guide is general information. Plan details, prices and enrollment dates vary; check HealthCare.gov, your state marketplace or your employer for current information.