Written by Alex Seleznev, MBA, CFP®, CFA and Alyssa Neece | Nov 19, 2025
Healthcare costs are one of the most significant variables in any budget.
The annual open enrollment period is not just a routine administrative task.
It is a critical window for financial planning.
For 2026 coverage, a simple auto-renewal could have significant and costly consequences.
Today I’d like to discuss this timely topic to help you as you navigate your healthcare open enrollment options.
Key Deadlines
For those using Medicare, the Medicare Annual Enrollment Period (AEP) is October 15 to December 7, 2025.
Use this time to enroll in, drop, or switch Medicare Advantage (Part C) or Prescription Drug (Part D) plans to take effect January 1, 2026.
And for those using the ACA or state marketplaces, your open enrollment is November 1, 2025 to January 15, 2026.
To guarantee that coverage begins on January 1, 2026, you must enroll in or change your plan by December 15, 2025, in most states.
Heads up - subsidies might be sunsetting
For clients utilizing the Health Insurance Marketplace, 2026 presents a substantial financial risk due to the potential expiration of enhanced federal financial assistance.
The enhanced Premium Tax Credits (PTCs), which were expanded and extended through the Inflation Reduction Act, are currently set to expire at the end of 2025.
If Congress does not act to extend these enhancements, millions of Americans will face sharp increases in their monthly premiums.
The temporary elimination of the subsidy cliff, which allowed households earning above 400% of the Federal Poverty Level to receive credits, is set to end.
If your income is near or slightly above this threshold, your cost for coverage could jump dramatically.
Now Let’s Dive In: 6 Questions to Consider as You Shop
As much as we can plan, we cannot expect the unexpected. That is the point of insurance!
But we can do our best to be thoughtful about our truly needed coverage by asking these 6 questions.
Do I have an expected surgery, new diagnosis, or an increase in specialist visits planned for 2026?
If yes, favor a plan with a lower deductible to minimize your out-of-pocket costs early in the year.
Planning for significant events (surgery, pregnancy, chronic care) makes high-premium, low-deductible plans (such as Gold/Platinum or specific Medicare Advantage plans) more financially attractive.
Are my prescriptions still covered?
Drug tiers and formularies change annually, especially for specialty or maintenance medications.
A plan with a low premium might place your vital medication in a high-cost tier.
This is crucial for Medicare Part D enrollees.
Confirm that your specific costly medications are covered on the new plan’s formulary and note what tier they are in.
Are all of my providers still in-network?
Networks shift and your preferred doctor or hospital may leave your plan.
This is especially true for Medicare Advantage and narrow-network ACA plans.
You must confirm that your current primary care physician and specialists are still "in-network" for the 2026 plan.
Also, consider if the network adequately covers you if you travel often or if you’ll have to shop for international coverage separately.
Am I really saving money choosing the lower tier?
Compare the total cost of care, not just the monthly premium.
The true total cost is calculated as the sum of (Monthly Premiums x 12) + Out-of-Pocket Maximum.
By comparing this total potential cost, you can determine which plan offers the best financial hedge based on your anticipated utilization (low, medium, or high).
Do I want to contribute to an HSA next year?
High Deductible Health Plans (HDHPs) paired with a Health Savings Account (HSA) offer triple tax advantages: contributions are tax-deductible, funds grow tax-free, and withdrawals for qualified medical expenses are tax-free.
If you select an eligible plan, ensure you factor in the tax savings of an HSA when comparing costs and plan to maximize your contributions.
Keep in mind that if you choose a plan that doesn’t offer HSA eligibility, you can still keep your account and use the funds currently in there.
You just won't be able to make contributions while you're enrolled in that plan.
Do I feel comfortable with the level of risk I am retaining?
This question really is referring to your out-of-pocket max.
As I mentioned earlier, we cannot predict the future.
Even if you’re incredibly careful to not get hurt or you have excellent health, there is a level of liability you are holding on to with every insurance plan.
So, if your out-of-pocket max is $10,000 and you are comfortable with covering this amount from your cash reserves or other sources, you are good to go.
If not, you may want to revisit your plan selection.
What does this mean to you?
It’s really a good habit to review your health insurance coverage on an annual basis.
Even if you don’t need to make any adjustments, it gives you a good reminder of what your policy covers and your ongoing costs.
But if your circumstances changed, it would be wise to proactively adjust your coverage so that you don’t experience any unpleasant surprises in the new year.