Article Summary
- A lower monthly premium usually comes paired with a higher deductible and higher out-of-pocket maximum, so the 'cheap' plan on paper can end up costing more for a household that uses healthcare regularly.
- Auto-renewal defaults you into your current plan if you do nothing, which quietly locks in last year's choice even if your employer changed the plan's terms, network, or premium for the new year.
- Checking whether specific doctors, specialists, and prescriptions are in-network for a candidate plan takes a few extra minutes but avoids the most common and most expensive open enrollment mistake.
"Personal finance is 80 percent behavior and only 20 percent head knowledge."
Jean Chatzky
Open enrollment tends to arrive at the busiest, least convenient time of year, buried in an email with a subject line most people skim past, attached to a portal with a countdown clock that makes the whole thing feel more urgent than thoughtful. The path of least resistance is to let the current plan auto-renew and move on, and for a lot of people in a lot of years that turns out fine. But plans change year to year — premiums shift, networks narrow or expand, deductibles move — and a plan that was the obvious right choice last year isn't guaranteed to still be the right one this year, which is exactly the assumption auto-renewal quietly encourages people to skip checking.
Premium Isn't the Whole Cost
The monthly premium is the number displayed most prominently during enrollment, but it's only one piece of what a health plan actually costs over a year. Plans with lower premiums typically come with higher deductibles — the amount you pay out of pocket before the plan starts sharing costs — and often a higher out-of-pocket maximum, the total cap on what you'd pay in a worst-case year. A household that rarely visits the doctor and takes no regular prescriptions may come out ahead on a low-premium, high-deductible plan simply because they're unlikely to hit the deductible in a typical year. A household managing a chronic condition, expecting a birth, or anticipating a planned procedure is often better served by a higher-premium plan with a lower deductible, because the difference in what they'd pay once real healthcare use starts often outweighs the premium savings many times over. The only way to know which side of this you're on is to estimate your household's actual expected usage honestly rather than defaulting to whichever premium number looks smallest.
Check the Network Before Anything Else
A plan can look perfect on cost and still be a poor fit if your regular doctors, a specialist you see for an ongoing condition, or your preferred hospital aren't in its network, since out-of-network care is typically reimbursed at a much lower rate or not at all depending on the plan type. This is especially important when switching insurers or plan types during open enrollment rather than simply renewing, since a new plan's network can differ substantially from what you're used to even within the same employer's benefits menu. It's worth calling the insurer directly or checking the plan's specific provider directory rather than relying on general reputation, since a large insurer's overall network size says little about whether your specific doctor happens to be included. The same applies to regular prescriptions — checking a plan's drug formulary for anything taken regularly can reveal a coverage tier difference that meaningfully changes the real cost of staying on a medication.
Don't Skip the Account Options Bundled In
Open enrollment is also usually when employees choose or re-elect contributions to a health savings account (HSA) or flexible spending account (FSA), and this decision deserves its own attention rather than being an afterthought to the plan choice itself. An HSA is generally only available alongside a qualifying high-deductible health plan, and contributions typically reduce taxable income while unused balances can often roll over and even be invested for long-term growth, which is meaningfully different from an FSA, where balances are commonly subject to a use-it-or-lose-it rule within the plan year or a short grace period. Estimating predictable healthcare costs for the coming year — a known prescription, planned dental work, an expected procedure — helps set a contribution amount that isn't left sitting unused or, in an FSA's case, forfeited. This is also the time to revisit dependent care FSA elections, life insurance elections, and disability coverage options bundled into the same enrollment window, since these are typically only adjustable once a year outside of a qualifying life event.
A Simple Open Enrollment Routine
Block out real time for this rather than treating it as a five-minute task squeezed between meetings. Start by listing the household's actual healthcare use from the past year — visits, prescriptions, any planned procedures for the year ahead — as the basis for estimating usage rather than guessing. Then compare at least two plan options side by side on total expected annual cost (premium plus realistic out-of-pocket spending), not premium alone, and verify network and formulary coverage for your specific doctors and medications before finalizing anything. Finally, don't let the plan choice crowd out the account elections bundled into the same window — HSA or FSA contributions, dependent care elections, and any voluntary benefits — since those are usually locked in for the year just like the health plan itself. Set a calendar reminder well before next year's open enrollment opens so the same review happens again rather than defaulting to auto-renewal out of habit.