Open Enrollment FAQs

Open enrollment is an important annual event where you can review and update your employee benefits for the upcoming year. We understand that choosing the right options can feel overwhelming, so we’ve created this guide to help you make informed decisions that align with your financial plan.

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First Step: Review Your Current Coverage and New Plan Options

Before making any changes, assess your current coverage to see if it still fits your needs. Here are some key factors to consider:

• Do you frequently visit the doctor or need specialists? If so, a lower deductible plan might be worth the higher monthly premiums.
• Are you generally healthy? If you don’t use your medical insurance much, a higher deductible plan with lower premiums might save you money.
• Are your doctors in-network? Make sure your preferred doctors and hospitals are still in-network for the upcoming year. If you're changing plans, make sure that you verify your doctors are in-network for your new plan.
• What are the max-out-of-pocket costs? The max-out-of-pocket (MOOP) limit protects you from catastrophic healthcare costs. This gives you a clear idea of the max amount of money would owe if you have a major health event.
  
  If you anticipate high medical expenses in the upcoming year, selecting a plan with a lower MOOP can help protect your finances. For example: 

  • If you’re healthy and rarely use healthcare services: You might choose a plan with a higher deductible and higher MOOP but lower monthly premiums. You’re betting that your medical needs will remain low, and the lower premiums can save you money.

  • If you have a chronic condition or expect significant medical care: You may want a plan with a lower MOOP. While you’ll pay more in premiums, your out-of-pocket costs will be capped for the year, giving you more predictable healthcare expenses and peace of mind.

Regardless of your choice, many plans cover basic preventative care at no cost, such as annual physicals and screenings.

Here is a checklist that you can use during your review.

While checklists can help you spot good ways to identify all the different opportunities to consider, we are always available to meet with you to discuss your finances and goals and to identify what the best opportunities are for you.

Open Enrollment FAQs

Should I Choose a PPO, HDHP, or HMO?

Choosing the right plans depends on your medical needs and how much you’re comfortable spending on premiums and out-of-pocket costs.

PPO (Preferred Provider Organization)

• Pros: Lower deductibles, larger network of doctors, no need for referrals to specialists.
• Cons: Higher premiums, higher costs if you use out-of-network providers.
• Best for: Individuals with ongoing medical needs or those who prefer flexibility in choosing healthcare providers.

HDHP (High-Deductible Health Plan)

• Pros: Lower premiums, can pair with a Health Savings Account (HSA) for tax savings.
• Cons: Higher out-of-pocket costs before the insurance kicks in.
• Best for: Generally healthy individuals who don’t expect frequent medical needs and want to save on premiums while taking advantage of an HSA.

HMO (Health Maintenance Organization)

• Pros: Lower premiums, focuses on preventative care.
• Cons: Limited to a specific network of providers, no coverage for out-of-network care except in emergencies.
• Best for: Those who don’t mind a more restricted provider network and prefer lower premiums.

How Much Should I Spend Each Month on Health Insurance?

To compare the overall costs of different health plans, familiarize yourself with these key terms:

• Premium: The amount you pay each month for coverage.
• Deductible: The amount you must pay out-of-pocket for services before your insurance starts covering costs.
• Copay: A fixed amount you pay for specific services (e.g., $20 per doctor visit).
• Coinsurance: The percentage of costs you share with the insurer after meeting your deductible.
  
  

Insurance plans usually lower premiums by raising the deductible or vice versa. If you’re healthy and rarely visit the doctor, you might prefer a plan with a lower premium and higher deductible. If you have a chronic condition or expect frequent healthcare needs, a plan with higher premiums but lower out-of-pocket costs may be better for managing your overall spending.

What Is an HSA and How Does It Work?

A Health Savings Account (HSA) is a savings account for people with an HDHP. It allows you to:

• Contribute pre-tax money: This reduces your taxable income.
• Grow savings tax-free: Your balance can be invested and grow tax-free.
• Use tax-free withdrawals: Pay for qualified medical expenses with no taxes on the money withdrawn.

HSA funds are yours to keep, and any unused funds roll over year to year. Once your balance reaches a certain threshold, many HSAs allow you to invest the funds to further grow your savings.

How Much Should I Contribute to My HSA?

Many employers offer matching contributions to your HSA, which is essentially free money for your healthcare. Aim to contribute enough to get the full employer match. If possible, try to contribute enough to cover your expected out-of-pocket medical costs for the year.

Should I Get Dental and/or Vision Insurance?

If your employer offers dental and vision insurance, consider whether you or your family might need these services in the coming year. For example:

• Dental insurance: Important if you expect major work like root canals, crowns, or other dental procedures. If you are anticipating orthodontic work, make sure you understand whether your dental insurance covers this.  
• Vision insurance: Worth considering if you or a family member requires glasses or contacts, or if regular eye exams are needed.

How Much Life Insurance Do I Need?

Term life insurance is one of the simplest and most affordable ways to ensure your family or dependents are financially protected in the event of your passing. The challenge, however, is determining how much coverage is enough. 

Check out our Term Life Insurance Guide for 3 simple ways to calculate how much you need.