Healthcare Planning Before Open Enrollment

August 18, 2025

Healthcare Planning Before Open Enrollment: What You Need to Know

Fall is just around the corner, which means cooler weather, back-to-school season, and football on the weekends. But for millions of Americans, it also means something less exciting but very important: open enrollment for healthcare. Whether you get insurance through your employer, the Affordable Care Act (ACA) marketplace, or Medicare, the choices you make this fall will affect your health and your wallet in 2025.

If you’ve ever felt overwhelmed by healthcare decisions, you’re not alone. Deductibles, premiums, co-pays, and networks can be confusing. But with a little planning, you can make the right choices for your family and avoid big financial surprises later. Let’s break it down step by step.

What is Open Enrollment?

Open enrollment is the time each year when you can make changes to your health insurance plan. Outside of open enrollment, you usually can’t change your plan unless you qualify for a special enrollment period (like losing your job, getting married, or having a baby).

Employer Plans: Most companies hold open enrollment sometime between September and November. Your HR department will give you the dates.
ACA Marketplace Plans: For 2025 coverage, open enrollment runs November 1, 2024 through January 15, 2025, though some states may have slightly different timelines.
Medicare: Open enrollment is October 15 through December 7, 2024. During this time, you can switch between Original Medicare and Medicare Advantage or change prescription drug plans.

Mark these dates on your calendar now, because missing them could leave you stuck with the wrong coverage for another year.

Why Planning Ahead Matters

Healthcare costs are rising, and picking the wrong plan can be expensive. For example:

A lower monthly premium may sound good, but it usually means higher deductibles and out-of-pocket costs.
A plan with a small provider network might not cover your current doctor.
Prescription drug coverage can vary widely between plans.

If you wait until the last minute, it’s easy to just pick the cheapest plan or stick with what you had last year. But your health needs and your budget may have changed. Planning ahead helps you find a balance between cost and coverage.

Step 1: Look Back at Your Healthcare Spending

Before you look at new plans, review what you spent this past year:

Doctor Visits: How often did you or your family see a doctor or specialist?
Prescriptions: Did you need regular medications? Did your costs surprise you?
Out-of-Pocket Costs: How much did you actually pay beyond premiums?
Upcoming Needs: Do you expect new medical expenses, like surgery, pregnancy, or ongoing therapy?

This snapshot will help you figure out what type of plan makes sense going forward.

Step 2: Understand the Key Terms

Healthcare jargon can be tricky. Here are the basics:

Premium: The amount you pay each month for insurance.
Deductible: The amount you must pay before insurance starts covering costs.
Co-pay: A fixed amount you pay for a doctor visit or prescription.
Coinsurance: The percentage you pay after meeting your deductible.
Out-of-Pocket Maximum: The most you’ll pay in a year. After this, your insurance covers 100%.

When comparing plans, don’t just look at the premium. A cheaper premium may come with a very high deductible, which can hurt if you have big medical bills.

Step 3: Compare Your Options

Now it’s time to shop around.

Employer Coverage:

Review the summary of benefits HR provides.
Check if your doctors and hospitals are in-network.
Compare high-deductible health plans (HDHPs) vs. PPOs or HMOs. HDHPs often pair with a Health Savings Account (HSA), which offers big tax advantages.

ACA Marketplace:

Log in to healthcare.gov starting November 1.
See if you qualify for subsidies or tax credits. Many families making under 400% of the poverty line get help lowering premiums.
Look at Silver plans if you want cost-sharing reductions that lower deductibles and co-pays.

Medicare:

Compare Part D drug plans carefully. Each plan covers medications differently.
If you’re on Medicare Advantage, review changes to provider networks and out-of-pocket costs.

Step 4: Think Beyond Health Insurance

Healthcare planning isn’t just about medical insurance. Consider these add-ons:

Dental and Vision Plans: Often separate from medical insurance but worth having, especially for families with kids or people who wear glasses.
Flexible Spending Accounts (FSAs): Offered by many employers, FSAs let you set aside pre-tax money for medical costs. Be careful though—unused money usually doesn’t roll over.
Health Savings Accounts (HSAs): If you choose a high-deductible health plan, an HSA lets you save pre-tax money that rolls over year to year. HSAs can even double as retirement accounts.

Step 5: Watch Out for Common Mistakes

Here are some pitfalls to avoid:

Not Checking the Network: Make sure your doctors and hospitals are covered.
Ignoring Prescription Coverage: A cheap plan may leave you paying full price for your meds.
Choosing Based on Premium Alone: The lowest monthly payment isn’t always the best deal.
Forgetting About Worst-Case Scenarios: Even if you’re healthy, a major accident or illness can cost thousands. Look at the out-of-pocket maximum.

Bottom Line

Healthcare may not be exciting, but it’s one of the biggest parts of your financial plan. Choosing the right coverage during open enrollment can save you hundreds—or even thousands—of dollars next year. Start reviewing your options now, set reminders for key dates, and don’t be afraid to ask questions if something doesn’t make sense.

Your health and your money are too important to leave to chance. By planning ahead, you’ll have peace of mind knowing you’ve made the best choice for your family.

Securities offered through Registered Representatives of Cambridge Investment Research, Inc., a Broker/Dealer, Member FINRA/SIPC. Advisory services offered through Cambridge, a Registered Investment Advisor. Sound Foundation Wealth Advisors and Cambridge Investment Research, Inc. are not affiliated. The information in this email is confidential and is intended solely for the addressee.