Insurance

The Open Enrollment Checklist: What to Review Before You Pick a Plan

Updated Jan 21, 2023· 5 min read
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In This Article

Key Takeaways

Monthly premiums are only one part of your true annual cost — always factor in deductibles and out-of-pocket maximums.
Verify that your current doctors and hospitals are in-network before selecting any plan.
Check the drug formulary to confirm your prescriptions are covered and at what cost tier.
HMO, PPO, EPO, and HDHP plan types differ significantly in flexibility and cost structure.
FSA and HSA eligibility depends on which plan type you choose — confirm compatibility before enrolling.
Open enrollment deadlines are firm; missing them typically means waiting until the next cycle.
30–60 min

Summary

18 items · 30–60 minutes

Why a Systematic Approach Pays Off

Open enrollment is one of the most consequential financial decisions many Americans make each year, yet it's easy to rush through it. A plan that looked affordable in October can turn expensive by February if your preferred specialist is out-of-network or your maintenance medication sits in a high-cost formulary tier. This checklist is designed to slow that process down in a productive way.

For background on what open enrollment actually governs — including the exact dates and what triggers exceptions — see what the ACA's open enrollment period actually governs. If a life event has already changed your situation, navigating a special enrollment period after a life change explains when you may qualify to enroll outside the standard window.

Work through each section below before you finalize any selection. This article is general educational information — not personalized insurance or financial advice. Coverage terms, costs, and eligibility vary by plan and by state, so always read plan documents carefully and consult a licensed insurance agent or navigator if you have specific questions.

Required

Plan's Summary of Benefits and Coverage (SBC)

The standardized SBC document lets you compare cost-sharing and coverage rules across plans on an apples-to-apples basis.

Required

Insurer's Online Provider Directory

Use this to verify that your current doctors and facilities are in-network before you enroll.

Required

Plan Drug Formulary

The formulary lists covered medications by tier so you can estimate prescription costs under each plan.

Optional

Healthcare.gov Plan Comparison Tool

Marketplace shoppers can use this official tool to view side-by-side plan details and estimate tax credits.

Optional

Licensed Insurance Agent or Navigator

A navigator or licensed agent can help you interpret plan differences and find assistance programs at no cost to you.

The Complete Open Enrollment Checklist

The checklist below groups tasks into logical phases. Complete the preparation steps first — gathering documents and usage data — before moving into plan comparison. That sequence prevents you from evaluating plans against incomplete information.

Preparation

Gather last year's Explanation of Benefits (EOB) statements to understand what services you actually used. Must
List every prescription medication you take and note the exact dosage — you'll need this to check formularies. Must
Write down the names of every doctor, specialist, hospital, and lab you currently use or expect to use. Must
Note any planned medical events for the coming year — surgeries, pregnancies, or ongoing specialist care. Should
Confirm your household size and income estimate to check whether you qualify for premium tax credits on the marketplace. Should

Cost Structure

Compare monthly premiums across all eligible plans, but do not treat premium alone as the total cost measure. Must
Identify the annual deductible for each plan — the amount you pay before insurance begins covering most services. Must
Locate the out-of-pocket maximum so you understand the ceiling on what you could owe in a bad year. Must
Review copay and coinsurance amounts for primary care, specialist visits, urgent care, and emergency room use. Must
Calculate a rough total annual cost scenario for both a healthy year and a year with significant medical use. Should

Network and Provider Access

Verify that each of your current providers is in-network for each plan you're seriously considering — check the insurer's provider directory directly. Must
Confirm whether any plan requires a primary care physician (PCP) referral to see specialists — HMOs typically do, PPOs typically do not. Must
Check whether out-of-network care is covered at all, and if so, at what cost — EPO plans generally exclude it entirely. Must
Confirm that preferred hospitals and outpatient surgery centers are in-network, not just your physicians. Should

Drug Coverage

Look up each of your medications on the plan's drug formulary and note which tier they fall into. Must
Check whether prior authorization or step-therapy requirements apply to any of your prescriptions. Should
Compare the cost of a 30-day supply versus a 90-day mail-order supply under each plan being considered. Nice to have

Savings Accounts and Benefits

Determine whether each plan is HSA-eligible — only high-deductible health plans (HDHPs) qualify, and HSA contribution limits are set by the IRS each year. Must
If your employer offers an FSA, check whether it's compatible with your chosen plan and what the use-it-or-lose-it rules are. Should
Review additional benefits such as mental health coverage, telehealth access, dental or vision add-ons, and preventive care coverage. Nice to have

Provider Directories Can Be Out of Date

Insurer provider directories are not always updated in real time. Before you rely on a directory listing, call the provider's office directly to confirm they accept the specific plan you're considering. A provider can be listed as in-network for an insurer but not for every plan that insurer offers.

Formulary Tiers Can Change Year to Year

Even if a medication was covered at a low cost tier last year, the plan may have moved it to a higher tier for the upcoming plan year. Always check the new plan year's formulary — do not assume last year's tier still applies.

For a deeper set of questions to ask about any specific plan you're considering, see our questions worth asking before you enroll in any health plan. If you're weighing lower-cost alternatives, short-term health plans: what they cover and where they fall short provides a balanced look at the tradeoffs involved.

Missing the Deadline Has Real Consequences

Open enrollment deadlines are set by federal and state rules and are not typically extended. If you miss the window, you generally cannot enroll in or change a marketplace or employer plan until the next open enrollment period — unless you qualify for a Special Enrollment Period due to a qualifying life event. Plan ahead and submit your selection before the deadline, not on it.

Insurance Editorial Team is the collective byline for our editorial team and contributor network. Articles published under this byline or an editorial pen name are researched, written, and reviewed according to our editorial standards for clarity, consistency, and independence before publication.

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Disclaimer: The content on this site is for informational purposes only and is not a substitute for professional advice. Always consult a qualified professional for guidance specific to your situation.