Prepping for Open Enrollment
Every fall, individuals and families face an important financial planning season: open enrollment. This is the annual window when you can review, update, or change your health insurance, Medicare coverage, and workplace benefits for the following year. Whether you receive coverage from your employer or are purchasing through the health insurance marketplace, open enrollment is your opportunity to make sure your benefits align with your current health, financial situation, and long-term goals. Whether you’re selecting a new health plan, reviewing retirement contributions, or evaluating life insurance options, taking the time to make informed choices can save money and ensure you’re properly covered.
Understanding Health Care Plans and Accounts
Before diving into enrollment dates and strategies, it’s helpful to understand the different types of health plans and tax-advantaged accounts available.
- High Deductible Health Plan (HDHP): Typically comes with lower monthly premiums but higher out-of-pocket costs before insurance coverage begins. Works best for those who are generally healthy and want access to a Health Savings Account.
- Low Deductible Health Plan: Higher monthly premiums but lower costs when you need care. Often a better choice if you anticipate surgeries, chronic care needs, or pregnancy.
- Health Savings Account (HSA): Available only with an HDHP. Contributions are tax-deductible, funds grow tax-free, and withdrawals for qualified medical expenses are tax-free. HSAs also roll over year-to-year and can serve as a long-term savings tool.
- Flexible Spending Account (FSA): Funded with pre-tax dollars and can be paired with certain lower-deductible plans. FSAs are “use it or lose it” within the plan year (with limited rollover options), but they can be great for covering planned medical costs like surgeries or maternity care.
HMO vs. PPO: What’s the Difference?
When choosing a health insurance plan, you’ll often see the terms HMO and PPO. Both provide coverage, but they work differently in terms of flexibility, cost, and provider choice.
- HMO (Health Maintenance Organization)
- You must choose a primary care physician (PCP) who coordinates your care.
- Referrals are usually required to see a specialist.
- You must use doctors and hospitals within the plan’s network (no out-of-network coverage except for emergencies).
- Pros: Lower monthly premiums and out-of-pocket costs.
- Cons: Less flexibility; limited to network providers.
- PPO (Preferred Provider Organization)
- No requirement to choose a primary care doctor.
- Referrals are not required to see specialists.
- You can see out-of-network providers, but it usually costs more.
- Pros: Greater flexibility and provider choice.
- Cons: Higher premiums and out-of-pocket costs compared to HMOs.
Key Enrollment Dates
- Medicare: Open enrollment runs October 15 – December 7. At Axiom we recommend talking with a local Medicare expert because the health care system that surrounds you will often dictate which plan type is best.
- Individual Health Insurance: In most states (including Oregon), enrollment runs November 1 – January 15. Idaho residents should note a shorter window: October 15 – December 15. If you reside in a different state, be sure to check on the specific dates where you are and what your particular employer plan offers.
Employer Benefits to Review
- Health Insurance Decisions: Think ahead. If you know you’ll have major health expenses in the next year, such as surgery or a planned pregnancy, it may be more cost-effective to choose a low-deductible plan with an FSA rather than a high-deductible plan with an HSA. Look back on the previous year and add up your health care costs to get an idea what you may expect over the next year and use that value to make an informed decision on what type of plan is best for you and your family.
- Long-Term Disability Insurance: Employer-provided group coverage is usually cheaper and guaranteed issue (rarely denied coverage), and it doesn’t involve individual financial underwriting. This makes it a valuable benefit to secure during open enrollment for the security of any wealth accumulator’s plan.
Life Insurance: Employer-provided group life insurance is also usually guaranteed issue, but often more expensive than individual coverage. Evaluate your actual needs and compare group options with private policies. For those in unions or employee groups, guaranteed issue options may also be available outside of standard enrollment. Employer plans are typically non-portable, meaning they do not transfer with you upon separation of employment due to termination or retirement.
Medicare Considerations
Choosing the right Medicare supplemental plan often depends heavily on local provider networks. For example, local changes such as St. Charles Hospital in Bend, OR, no longer accepting Moda as an insurance carrier mean some individuals must switch plans to maintain access to their preferred providers or they may end up traveling across the state to stay in network. These local factors make personalized advice essential.
Maximizing Retirement Contributions
Open enrollment is also the perfect time to review retirement accounts:
- Make sure you’re taking advantage of your contribution limits to your Simple IRA, 401(k) or 403(b), especially if you’re age 50+ and eligible for catch-up contributions ($7,500). This year a “super catch-up” is also available for those 60-63 years of age ($11,250). Contribution limits for 2026 will likely increase so be aware of the new limits when selecting your deductions.
- If your income has increased, or you expect a high-income year, consider switching contributions from Roth to pre-tax deductible contributions to reduce your tax bill. The opposite is also the case… low-income year? Make Roth contributions.
- Don’t forget about 457 plans if eligible, which can often be used alongside a 401(k) or 403(b) and provide extra funding flexibility for long-term employees.
Best Practices During Open Enrollment
- Review your most recent pay stubs to see what benefits you’re paying for now.
- Consider upcoming life changes, such as retirement, starting a family, or major health care needs, that could impact your benefits choices.
- Talk to your advisor about any questions to make sure your selections align with your financial plan and long-term goals.
Final Thoughts
Open enrollment isn’t just about health insurance—it’s about your overall financial well-being. Reviewing your options carefully can help you save money, protect your family, and prepare for the future. If you’re unsure where to start, schedule time with your advisor this month to walk through your benefits and make confident, informed decisions.
Click here to schedule with Grant Finter in Bend, OR
Click here to schedule with George Luke in Moscow, ID