Fall may not immediately come to mind as an important financial planning season, but it is a good time to review your health insurance coverage for the coming year.
For Affordable Care Act (ACA) Marketplace plans, open enrollment begins November 1. Employer-sponsored plans have their own enrollment periods, many of which also occur in the fall.
It can be tempting to simply re-enroll in your current plan. But premiums, deductibles, provider networks and prescription coverage can change from year to year—and your healthcare needs may have changed as well. Taking a little time to compare your options can help avoid surprises later.
Look Beyond the Monthly Premium
One of the most common mistakes when comparing health insurance plans is focusing primarily on the monthly premium. While premiums are important, they are only one component of your potential healthcare costs.
When evaluating a plan, consider:
Deductible. This is generally the amount you pay for covered healthcare services before your insurance begins sharing the cost. Higher-deductible plans often have lower monthly premiums.
Copays and coinsurance. A copay is a fixed amount you pay for certain services, such as a doctor's visit or prescription. Coinsurance is the percentage of a covered expense you pay after satisfying your deductible.
Provider network. Make sure your preferred doctors, specialists and hospitals participate in the plan's network. Out-of-network care can be significantly more expensive and, depending on the plan, may not be covered at all.
Out-of-pocket maximum. This is generally the most you will pay during the year for covered, in-network healthcare services. Once you reach the limit, the plan typically pays 100% of covered, in-network costs for the remainder of the plan year. Premiums and most out-of-network expenses do not count toward this limit.
Prescription coverage. If you regularly take medications, review the plan's formulary to make sure your prescriptions are covered and determine which pricing tier applies.
HSA eligibility. If a plan is HSA-eligible, a Health Savings Account can be a valuable financial planning tool. Contributions may be tax-deductible, investment growth is tax-deferred, and withdrawals for qualified medical expenses are tax-free. Beginning in 2026, certain Bronze and Catastrophic Marketplace plans may also qualify for HSA contributions under updated federal rules.
Consider Your Total Potential Cost
Choosing health insurance is ultimately a tradeoff between what you know you will pay and what you might have to pay.
Someone who is relatively healthy and expects limited healthcare expenses may prefer a higher deductible in exchange for lower monthly premiums, particularly when the plan allows contributions to an HSA.
Someone with ongoing medical needs, regular prescriptions or anticipated procedures may benefit from paying a higher premium for a lower deductible, lower copays or a lower out-of-pocket maximum.
Rather than comparing premiums alone, consider several scenarios: What would the plan cost in a relatively healthy year? What would it cost in a year with moderate healthcare needs? And what is your maximum financial exposure if you have a significant medical event?
Changing Coverage During a Job Transition
Health insurance deserves additional attention when changing jobs.
COBRA generally allows you to temporarily continue coverage under a former employer's health plan. However, you typically become responsible for the entire premium, plus an administrative fee, because the former employer is no longer subsidizing the cost.
Losing employer-sponsored health insurance may also qualify you for a Special Enrollment Period through the ACA Marketplace. Depending on your circumstances, a Marketplace plan may be worth comparing with COBRA or coverage available through a new employer.
If you receive an ACA premium subsidy, estimate your annual household income carefully. The amount of financial assistance you ultimately qualify for is based on your actual income, and differences may need to be reconciled when you file your federal income tax return.
A job change can also create an HSA issue. If you or your employers contribute to multiple HSAs during the year, remember that the annual contribution limit applies to your combined eligible contributions—not separately to each account. For 2026, the HSA contribution limit is $4,400 for self-only coverage and $8,750 for family coverage, with an additional $1,000 catch-up contribution available for eligible individuals age 55 or older.
Give Your Health Coverage an Annual Checkup
Open enrollment is an opportunity to make sure your health insurance still fits both your healthcare needs and your broader financial plan.
Before automatically renewing your current coverage, compare premiums, deductibles, out-of-pocket maximums, provider networks, prescription coverage and HSA eligibility. A little additional work during open enrollment can help reduce unexpected costs and ensure that your coverage remains aligned with your financial situation.
If you would like help evaluating how your health insurance options fit within your overall financial plan, please feel free to reach out.
