What should we check when our health insurance renews?

In the US you usually choose your health plan once a year, in “open enrollment”. Most people get cover through work; others buy it on the ACA marketplace. Either way, the choice you make in the autumn mostly locks you in for the next calendar year.

Key terms

• Premium: what you pay each month for the plan, often taken from your salary before tax
• Deductible: what you pay for care each year before the plan starts paying
• Copay and coinsurance: your share after the deductible, either a fixed amount or a percentage
• Out-of-pocket maximum: the most you’ll pay in a year for covered, in-network care. After that the plan pays in full
• Network: the doctors and hospitals the plan has deals with. Going out of network can cost far more, or not be covered at all

Workplace open enrollment

Your employer will send details, usually in October or November, for cover from 1 January. If you do nothing, many employers roll you onto the same plan, but some don’t, so check. What to look at:

• Premium changes for you and your family, which often rise each year
• Whether your doctors, children’s paediatrician and nearest hospital are still in the network
• Your regular medicines: check the plan’s list of covered drugs (the formulary) and what tier they’re on
• PPO versus HMO: an HMO usually needs a referral from your primary care doctor to see a specialist and has a tighter network, but tends to cost less
• A high-deductible health plan (HDHP) has lower premiums and lets you save in a health savings account (HSA): money goes in before tax, grows tax-free and comes out tax-free for medical costs. Many employers add to it
• A flexible spending account (FSA) also lets you pay medical costs from pre-tax pay, but most of it is lost if you don’t spend it by the plan’s deadline
• Dental and vision plans are separate choices
• Add a new partner or child here, or within 30 days of a birth, adoption or marriage

The ACA marketplace

If you’re self-employed, between jobs, or your employer doesn’t offer cover, you can buy a plan on the marketplace: HealthCare.gov in most states, or your state’s own exchange. Lawfully present immigrants, including people on work visas, can usually use it. Plans can’t refuse you or charge more for pre-existing conditions.

A 2025 federal rule would have ended open enrollment on 15 December for HealthCare.gov states. A court set it aside in June 2026, and federal officials say the 1 November to 15 January window applies this year whatever the appeal decides. Dates could change for later years. Check your state exchange

• Subsidies (premium tax credits) depend on your household income and whether you’re offered affordable cover at work. The extra subsidies available from 2021 to 2025 ended after 2025, so many people pay more now. Use the marketplace’s own estimator
• If you already have a marketplace plan and do nothing, you’re usually re-enrolled automatically. Log in anyway: prices, subsidies and networks change each year
• Report income and household changes during the year, or you may have to repay subsidy at tax time

Changing plans outside open enrollment

A qualifying life event opens a special enrollment period: usually 30 days for a workplace plan and 60 days on the marketplace. Common events are losing other cover (such as leaving a job), marriage, a birth or adoption, and moving to a new area. Moving to the US from abroad can also qualify for the marketplace. Keep proof of the date.

COBRA when you leave a job

COBRA lets you keep your old employer’s plan, usually for 18 months, at up to 102% of the full cost. You have 60 days to elect it. It can make sense mid-year if you’ve already paid most of your deductible, or are mid-treatment. Otherwise a marketplace plan is often cheaper. When COBRA runs out, you get a 60-day marketplace window; dropping it early doesn’t give you one. See changing jobs.