Don’t automatically renew your health insurance just because it’s the plan you already have.

Open Enrollment is your opportunity to take a fresh look at your health coverage and decide whether your current plan still makes sense for your health needs, your doctors, your prescriptions, and your budget.

At Life and Med: Medicare Resource Center, we believe choosing health insurance shouldn’t feel overwhelming. A little review now can help you avoid unpleasant surprises later.

Here’s what to look at before making your decision.

What Is Open Enrollment?

Open Enrollment is a specific period when you can enroll in health coverage or make changes to your existing plan.

Depending on your situation, you may get health insurance through:

• An employer
• The Health Insurance Marketplace
• Medicare
• Another health coverage program

Enrollment dates and rules are different depending on the type of coverage you have, so it’s important to know which enrollment period applies to you.

You may also be able to change coverage outside of Open Enrollment if you experience a qualifying life event, such as:

• Getting married or divorced
• Having a baby
• Losing other health coverage
• Moving to a new coverage area

Don’t Just Renew—Review!

It’s easy to think:

“My plan worked fine last year, so I’ll just keep it.”

But insurance plans can change from year to year.

Your premium may increase. Your deductible may change. Your doctor could leave the network. A prescription that was inexpensive may move to a different drug tier.

That’s why Open Enrollment is the perfect time to review your coverage from top to bottom.

Step 1: Look Back at the Past Year

Before choosing a plan, think about how your current coverage actually worked for you.

Ask yourself:

• Were my doctors in-network?
• Was my preferred hospital covered?
• Were my prescriptions covered?
• Did I have unexpected medical bills?
• Was my deductible affordable?
• Did I have trouble getting services approved?
• Did I avoid medical care because of the cost?
• Did I use benefits that I was paying for?
• Has my health situation changed?

Your experience from the past year can give you valuable clues about what you may need going forward.

Step 2: Think About Your Healthcare Needs for the Coming Year

Nobody can predict everything that will happen medically, but you may already know about healthcare needs coming up.

For example, you might anticipate:

• Regular doctor visits
• Specialist appointments
• Prescription medications
• Physical therapy
• Mental health services
• Lab work or imaging
• A planned procedure
• Surgery
• Pregnancy and maternity care
• Medical equipment or supplies

If you know you’re going to need more healthcare next year, a plan with the lowest monthly premium may not necessarily be the best financial choice.

Step 3: Check Your Doctors and Hospitals

This is one of the most important steps when comparing plans.

Don’t assume that because an insurance company is the same, your doctors will automatically remain in-network.

Check whether your new plan includes:

• Your primary care doctor
• Your specialists
• Your preferred hospital
• Your healthcare system
• Your laboratory
• Imaging centers
• Mental health providers
• Your preferred pharmacy

And here’s an important tip:

Check the specific plan—not just the insurance company.

An insurance company may offer several plans with completely different provider networks.

Step 4: Check Your Prescription Coverage

If you take medications regularly, don’t skip this step.

Review the plan’s list of covered medications, commonly called a formulary.

Check:

• Is my medication covered?
• What tier is it on?
• What will I pay?
• Is there a quantity limit?
• Does it require prior authorization?
• Do I need to try another medication first?
• Is there a preferred pharmacy?

Your prescription coverage can change even if you stay with the same insurance company.

Step 5: Don’t Look at the Premium Alone

One of the biggest mistakes people make during Open Enrollment is choosing a plan based solely on the monthly premium.

A lower premium can sometimes come with higher out-of-pocket costs.

When comparing plans, look at the whole picture.

💰 Premium

This is what you pay to maintain your coverage.

Calculate what you’ll pay over the entire year, not just each month.

💵 Deductible

Your deductible is the amount you generally pay for covered healthcare before your plan begins paying more of the costs.

🧾 Copays

A copay is a set amount you may pay for a particular service, such as a doctor visit or prescription.

📊 Coinsurance

Coinsurance is the percentage of a covered service you may be responsible for after meeting certain plan requirements.

🛡️ Out-of-Pocket Maximum

This can be one of the most important numbers to understand.

It represents the maximum amount you generally pay toward covered in-network services during the plan year, although premiums and certain other costs may not count toward the limit.

Ask yourself: “If something unexpected happened, could I afford this plan?”

Step 6: Compare a “Normal Year” and a “Bad Year”

Here’s a simple way to compare two plans.

In a typical year, consider:

• Annual premiums
• Doctor visits
• Prescriptions
• Regular treatments
• Expected healthcare expenses

Then consider a high-cost year:

• Annual premiums
• Deductible
• Coinsurance
• Copays
• Out-of-pocket maximum

A plan that looks inexpensive based on its monthly premium could become much more expensive if you suddenly need surgery, hospitalization, or extensive treatment.

You’re not trying to predict the future. You’re trying to understand your financial risk.

Step 7: Understand How Your Plan Works

Two plans can have similar premiums but work very differently.

Before enrolling, find out:

• Do I need to choose a primary care provider?
• Do I need referrals for specialists?
• Is out-of-network care covered?
• How large is the provider network?
• Do certain services require prior authorization?
• What hospitals can I use?

Don’t choose a plan based solely on its name or insurance company.

Understand how the specific plan actually works.

Step 8: Look Beyond Medical Insurance

Your Open Enrollment choices may include more than your medical plan.

Depending on what’s available to you, review:

• Dental coverage
• Vision coverage
• Prescription coverage
• Mental health benefits
• Telehealth
• Physical therapy
• Rehabilitation services
• Maternity benefits
• Supplemental benefits

Don’t assume that a benefit works the same way on every plan.

Medicare Open Enrollment Is Different

📅 Medicare Open Enrollment

October 15 – December 7

Changes made during this period generally become effective January 1, the following year

If you’re already enrolled in Medicare, your Open Enrollment options and dates are different from those for individual or employer health insurance.

Medicare beneficiaries may need to review:

• Medicare Advantage plans
• Medicare Part D prescription drug plans
• Medicare Supplement options
• Provider networks
• Prescription formularies
• Premiums and other costs
• Changes to their current plan

Your Medicare plan can change from year to year, too.

That’s why Medicare beneficiaries should review their Annual Notice of Change and compare their coverage before deciding to stay with their current plan.

Marketplace Open Enrollment is different

Your Open Enrollment Checklist

Before you enroll, ask yourself:

☑️ Are my doctors still in-network?
☑️ Is my preferred hospital covered?
☑️ Are my prescriptions covered?
☑️ What will I pay in premiums for the entire year?
☑️ What’s the deductible?
☑️ What are my copays?
☑️ What’s the coinsurance?
☑️ What’s the out-of-pocket maximum?
☑️ Do I need referrals?
☑️ Is out-of-network care covered?
☑️ Do I need prior authorization?
☑️ Am I eligible for an HSA or FSA?
☑️ Has anything changed about my health or finances?
☑️ Could another plan better fit my needs?

Don’t Go Into Open Enrollment Alone

Choosing health insurance can be confusing, especially when you’re trying to compare premiums, deductibles, provider networks, prescription coverage, and out-of-pocket costs all at once.

That’s where Life and Med: Medicare Resource Center can help.

We’re here to help you understand your options and make an informed decision based on your healthcare needs and your budget.

Whether you’re approaching Medicare, already on Medicare, or looking at health insurance options, don’t simply renew because it’s familiar.

Take a fresh look. Compare your options. Make sure your coverage still fits your life.

📍 Life and Med: Medicare Resource Center

216 N. 3rd St., Suite B
Leesburg, FL 34748

📞 352-260-0202

Life and Med: Making Health Insurance Easier to Understand—One Plan at a Time.