How to Choose the Right Health Plan at Open Enrollment

Why Most People Choose the Wrong Health Plan

Open enrollment windows are typically two to three weeks long, yet surveys consistently find that most employees spend less than 30 minutes evaluating their options. The most common approach: pick the same plan as last year, or choose the one with the lowest monthly premium.

Both strategies can cost thousands of dollars annually. The plan with the lowest premium is not always the cheapest plan — once you add deductibles, copays, coinsurance, and out-of-pocket maximums, a higher-premium PPO frequently costs less than an HDHP for employees with moderate or high medical usage.

The good news: choosing correctly requires only four numbers — your expected medical usage, the monthly premium, the deductible, and the out-of-pocket maximum — and about 15 minutes. The Health Plan Comparison Tool does the math for you.

Compare Your Plans in 5 Minutes

Enter your two plans' details and your expected usage level. The tool shows your true annual cost, worst-case exposure, and exactly which plan wins — including the crossover point where each plan becomes cheaper.

Compare My Health Plans

The Five Numbers That Actually Determine Your Cost

Monthly premium is the most visible cost — it comes out of every paycheck. But it's only one of five numbers that determine what you'll actually pay in a plan year.

Deductible: the amount you pay before insurance shares costs. On an HDHP, this might be $1,500–$3,000. On a PPO, $250–$1,000. Until you hit the deductible, you're paying full cost for most services.

Coinsurance: your share of costs after the deductible, typically 20%. After a $500 procedure with a $1,000 deductible already met, you pay $100 (20%) and insurance pays $400.

Out-of-pocket maximum: the most you'll ever pay in a plan year. After hitting this number, insurance covers 100%. This is your worst-case protection — and for high-usage employees, it's often the most important comparison point.

Employer HSA contribution: if your HDHP is HSA-eligible, your employer may contribute $500–$1,500 directly to your Health Savings Account. This is real compensation that directly reduces your net plan cost.

How to Compare Health Plans in 4 Steps

1
Estimate your medical usage for the year
Think about last year: how many times did you visit a primary care doctor? A specialist? How many prescriptions do you fill regularly? If you had a major life event (new baby, surgery, diagnosis), factor that in. Low usage = 0–4 visits per year. Medium = 5–10. High = 10+ or any regular specialist or prescription care.
2
Enter both plans' key numbers into the comparison tool
You need: monthly premium, deductible, out-of-pocket maximum, coinsurance percentage, and copay amounts for primary care, specialist, and Rx. These are in your plan documents — look for the Summary of Benefits and Coverage (SBC), which all plans are required to provide.
3
Check the crossover chart
The crossover point shows the medical spending level where one plan becomes cheaper than the other. If your expected spending is well below the crossover, the lower-premium plan wins. If you're likely to hit the crossover due to high usage, the lower-deductible plan may save money despite the higher premium.
4
Verify your providers are in-network
Cost comparison is only valid if your preferred doctors and hospital are in-network. Call your key providers and ask which plans they accept before finalizing your decision. Out-of-network care can cost 2–5× more and blow up even the most favorable plan comparison.

HDHP vs PPO: When Each Wins

HDHP Usually Wins When...

✓You're generally healthy with few doctor visits per year
✓Your employer contributes significantly to an HSA
✓You can afford to pay the deductible from savings if needed
✓You want to build a tax-advantaged medical savings account
✓The premium savings exceed your expected additional OOP costs
✓You're young and single with no regular prescriptions

PPO Usually Wins When...

✗You have a chronic condition requiring regular specialist care
✗You take brand-name or specialty medications regularly
✗You're planning a pregnancy or have young children
✗Your expected medical costs routinely approach or exceed the deductible
✗You prefer predictable copays over coinsurance uncertainty
✗The employer HSA contribution is small or nonexistent

Can I change my health plan outside of open enrollment?

Generally no — health plan elections are locked in until the next open enrollment unless you have a qualifying life event (QLE). QLEs include marriage, divorce, birth or adoption of a child, loss of other health coverage, or moving to a new coverage area. You typically have 30–60 days from the QLE to make a plan change.

What is the difference between in-network and out-of-network?

In-network providers have contracted rates with your insurer — you pay the lower negotiated cost. Out-of-network providers charge market rates, and your insurance pays a smaller portion or nothing at all. HDHPs often have no out-of-network coverage except for emergencies. PPOs typically cover out-of-network at a higher cost-sharing rate.

Should I max my HSA every year?

If you can afford it, yes. The HSA's triple tax advantage makes it one of the most powerful savings vehicles available. In 2024, you can contribute up to $4,150 (individual) or $8,300 (family). Unused funds roll over indefinitely and can be invested. After age 65, HSA funds can be withdrawn for any purpose without penalty (just taxed as income), making it a de facto second retirement account.

What if my employer only offers one health plan?

If you have only one employer plan available, the comparison tool can help you evaluate whether to use the employer plan or shop for individual coverage on the ACA marketplace — particularly relevant if your employer plan has high premiums relative to your income or limited provider networks.