What to Know Before Open Enrollment Begins

Open enrollment is approaching, and for many people the process will look familiar: review the available plans, look at the monthly premiums, and decide whether to keep the same coverage for another year.

But the plan with the lowest premium isn’t necessarily the plan that will cost you the least, and the plan you have today may not be the best fit for you next year.

Before open enrollment begins, take some time to look at how you actually used your healthcare this year. Your claims, prescriptions, provider visits, and out-of-pocket expenses can tell you a lot about what to focus on when comparing plans.

Start by looking at more than the premium. A health plan with a lower monthly cost may have a higher deductible or require you to pay more when you receive care. Another plan may cost more each month but provide different cost-sharing for the services you use most often. Consider not only what comes out of your paycheck each month, but how the plan may work when you really need care.

Think about your providers too. If keeping a particular doctor, specialist, hospital, or medical group is important to you, don’t assume they will be available under every plan. Provider networks can differ between plans and can change from year to year.

If you take prescription medications, it’s a good idea to make a list of them. Health plans use formularies to determine medication coverage, and the same prescription may have different out-of-pocket costs depending on the plan, medication tier, and pharmacy network.

If you’re considering an HSA-compatible health plan, look beyond the higher deductible. Consider the difference in premiums, whether you plan to contribute to an HSA, and what you may need to pay out of pocket. Looking at these pieces together can give you a better picture of the potential overall cost.

You can’t predict what your healthcare needs will be next year, but you can use what you know today to make a more informed decision about your coverage.

When your open enrollment materials arrive, think about what worked well with your current coverage, what didn’t, and what may be changing for the coming year. No single plan is right for everyone, so taking a little time to review your options can help you feel more confident about the coverage you choose.

CalCPA Health Members

Have questions about your current coverage or want to better understand your plan before open enrollment? Review your plan’s Summary of Benefits and Coverage (SBC) on the CalCPA Health website or contact our Service Center for help understanding your benefits and coverage options.

View Your Plan’s Summary of Benefits and Coverage (SBC)

Questions? Customer Support