The Ultimate Survival Guide to Open Enrollment

What you need to know about Open Enrollment for individuals, brokers, and employers.

Open enrollment can feel overwhelming — premiums, deductibles, networks, and deadlines all shift from year to year. But this is also your one chance to make sure your coverage fits your life. This guide explains everything you need to know about open enrollment for 2025. Whether you are an individual choosing coverage, an employee reviewing your workplace benefits, or an employer planning for your team, you will learn how open enrollment works, what benefits are included, and how to prepare. We also include key dates, practical tips, and checklists so you can make confident decisions this season.


What Is Open Enrollment?

Open enrollment is the annual period when individuals and employees can make changes to their health insurance coverage and other employer-sponsored benefits. During this time, you can:

  • Enroll in a new health insurance plan

  • Switch from one plan type to another (for example, moving from a Preferred Provider Organization to a High Deductible Health Plan)

  • Add or remove dependents from your coverage

  • Sign up for or adjust additional benefits like dental insurance, vision insurance, and savings accounts for healthcare costs

Outside of this window, you generally cannot make changes unless you qualify for a Special Enrollment Period triggered by a major life event. These events, called qualifying life events, include things like getting married, having a child, or losing other coverage.

The key takeaway is that open enrollment is the main opportunity each year to ensure your health insurance and benefits still meet your needs.


When Is Open Enrollment 2025?

Open enrollment for 2025 depends on where you get your coverage.

  • Marketplace coverage (healthcare.gov): Open enrollment begins on November 1, 2024, and ends on January 15, 2025. If you want coverage to start on January 1, 2025, you must enroll by December 15, 2024.

  • State-based exchanges: Some states run their own health insurance marketplaces and may set different dates. Always confirm the open enrollment schedule for your state if you do not use healthcare.gov.

  • Employer-sponsored coverage: Employers choose their own open enrollment periods, which are often in the fall. Ask your human resources team for your company’s specific dates.

Missing your open enrollment period can leave you with limited options or without coverage for the year ahead. Unless you qualify for a Special Enrollment Period, you will need to wait until the next open enrollment window to make changes.


Who Qualifies for Open Enrollment?

Anyone who is eligible for health insurance through their employer or through the marketplace qualifies to participate during open enrollment. This includes:

  • Employees offered benefits through their workplace

  • Individuals shopping for coverage on healthcare.gov or state exchanges

  • Dependents, such as spouses or children, who can be added to plans

  • People eligible for Medicaid or CHIP, which allow year-round enrollment

Medicare operates on a separate schedule, with its own open enrollment period each fall. If you are 65 or older, you may have different deadlines and rules than marketplace or employer coverage.


What Happens If You Miss Open Enrollment?

If you miss open enrollment, your options become limited. For employer plans, you may be locked into your current coverage for another year. For marketplace coverage, you may not be able to enroll in a new plan until the next open enrollment, unless you qualify for a Special Enrollment Period.

In some cases, if you do nothing, your coverage may automatically renew. However, your costs, provider networks, or prescription drug coverage could change without notice. Going without insurance altogether means you risk paying out-of-pocket for medical care until the next enrollment window. That is why it is critical to mark your calendar and prepare in advance.


What Is a Special Enrollment Period (SEP)?

A Special Enrollment Period allows you to sign up for or change your insurance outside of open enrollment if you experience a qualifying life event (QLE). Common examples include:

  • Marriage or divorce

  • Birth or adoption of a child

  • Losing health coverage due to job loss

  • Moving to a new ZIP code or state

  • Gaining U.S. citizenship

  • A significant change in household income

Special Enrollment Periods generally last 60 days from the date of the event, and you may need to provide documentation to prove eligibility. Without a QLE, you must wait until the next open enrollment period to make changes.


What Benefits Can You Choose During Open Enrollment?

Open enrollment is not just about medical insurance. It is your chance to review and update your full benefits package.

Medical Insurance Plans

  • Preferred Provider Organization (PPO): Broad provider networks and partial out-of-network coverage.

  • High Deductible Health Plan (HDHP): Lower premiums, higher deductibles, and eligibility for HSAs.

  • Health Maintenance Organization (HMO): Lower premiums and deductibles, but limited provider networks.

Dental and Vision Coverage: Many employers and exchanges offer add-on plans for dental and vision. These can cover preventive visits, orthodontics, eyeglasses, or contact lenses.

Tax-Advantaged Accounts

  • Health Savings Accounts (HSAs): Available if you are enrolled in an HDHP. Balances roll over year to year.

  • Flexible Spending Accounts (FSAs): Offered through employers. Funds must be used within the plan year, though some accounts allow small rollovers or grace periods.

  • Lifestyle Spending Accounts (LSAs): Employer-funded benefits for wellness, fitness, or personal development.

Other Employer Benefits Some employers also provide commuter benefits, disability insurance, life insurance, or wellness programs during open enrollment.


How to Prepare for Open Enrollment

Open enrollment is more than just picking a plan — it’s about aligning your coverage with your health needs and financial situation for the year ahead. Even if you’re satisfied with your current benefits, costs and coverage details often change annually. Taking time to prepare ensures you don’t face surprises later.

Start by reflecting on your overall healthcare patterns rather than just last year’s bills. Are you generally healthy with occasional visits, or do you have ongoing prescriptions and specialist care? Thinking in terms of trends, not just one-off expenses, helps you predict what kind of plan structure may fit best.

Next, weigh your financial comfort zone. A lower monthly premium may look appealing, but higher deductibles mean more risk if you end up needing unexpected care. On the other hand, a higher-premium plan can offer predictability if you know you’ll use medical services often. Deciding where you sit on that risk-versus-certainty spectrum is one of the most important steps in open enrollment.

Many people feel rushed during open enrollment, but slowing down to ask a few key questions can make the process far less stressful. As you prepare, ask yourself questions like:

  • How often did I (or my family) use healthcare last year, and do I expect that to change?

  • Could I afford to pay my plan’s deductible if a major expense came up?

  • Are my doctors, specialists, and prescriptions still covered under my plan?

  • Would contributing to an HSA or FSA make sense for my budget and long-term savings goals?

  • Am I expecting life changes — like marriage, a new child, or retirement — that could affect my needs?

With this preparation, open enrollment becomes less of a rushed deadline and more of a chance to align your healthcare and finances with where you are — and where you’re headed.


Open Enrollment Checklist

Open enrollment only comes once a year, so it’s important to approach it with a plan. This checklist will help you stay organized, avoid common mistakes, and choose the coverage that best fits your health and budget needs.

  • Review your current plan. Look at premiums, deductibles, copays, and provider networks to see if your coverage still fits your needs.

  • Estimate your healthcare usage. Consider how often you visit doctors, use prescriptions, or anticipate major life events in the year ahead.

  • Compare available plans. Evaluate PPOs, HDHPs, and other options based on total annual costs, not just monthly premiums.

  • Check provider networks. Make sure your preferred doctors, specialists, and hospitals are covered in-network.

  • Review prescription coverage. Confirm that your medications are included in the plan’s formulary at a cost you can afford.

  • Look at tax-advantaged accounts. Decide whether to contribute to an HSA or FSA to save on healthcare costs.

  • Confirm key deadlines. Mark important enrollment dates to avoid losing access to coverage changes.

  • Ask questions. If you are unsure, contact HR, your broker, or your plan’s customer support team before enrolling.

By following this checklist, you can simplify the open enrollment process and make sure you’re not overlooking important details. Taking time to compare costs, coverage, and savings opportunities now will pay off throughout the year.


Key Terms to Know for Open Enrollment

Understanding a few key terms will make it easier to compare plans and avoid surprises. These definitions are simple but important — you’ll see them often while reviewing your options.

  • Premium: The amount you pay each month to keep your insurance active. Example: If your premium is $400, you pay that whether or not you use care.

    Deductible: What you must pay out of pocket for covered care before insurance starts paying most costs. Plans with lower premiums often have higher deductibles.

    Co-pay: A fixed dollar amount for a service, such as $25 for a doctor visit. Co-pays apply even after meeting your deductible in many plans.

    Coinsurance: The percentage you pay for care after meeting your deductible. For example, you might pay 20% of a bill and your plan covers 80%.

    Out-of-pocket maximum: The most you’ll pay in a year for covered services. Once you reach it, insurance pays 100% of eligible costs for the rest of the year.

    In-network vs. out-of-network: In-network providers contract with your insurer, so you pay less. Out-of-network care is usually more expensive and may not be covered at all.

    Qualified medical expense: Costs the IRS allows you to pay with HSA or FSA funds, such as doctor visits, prescriptions, and preventive care.

Knowing these terms gives you the foundation to compare plans side by side and choose coverage that matches both your healthcare needs and your budget.


Open Enrollment for Individuals

For individuals, open enrollment is the main opportunity each year to update or switch health coverage. Even if you are satisfied with your current plan, reviewing your options is important. Premiums, provider networks, and drug formularies can all change, and if you let your plan automatically renew, you may face higher costs or lose access to your preferred doctor or medications without realizing it.

Marketplace enrollees should also confirm their eligibility for subsidies, which are based on income and household size. Updating your information each year ensures you receive the right amount of financial assistance. Subsidies can significantly reduce monthly premiums and out-of-pocket costs, making coverage more affordable.

Open enrollment is also the time to think about long-term planning. If you are healthy and rarely use care, a High Deductible Health Plan paired with a Health Savings Account (HSA) may lower costs while allowing you to save tax-free for the future.

Beginning in 2026, the One Big Beautiful Bill (OBBB) will expand HSA eligibility to certain ACA Bronze and Catastrophic plans. If you expect to consider one of these plans, reviewing your options now will help you prepare for new opportunities next year. Our OBBB HSA Guide explains what’s changing and how to plan ahead.


Open Enrollment for Employers

Employers play a central role in ensuring their teams understand and value the benefits available to them. A thoughtful open enrollment strategy not only boosts employee engagement but can also reduce administrative headaches and long-term healthcare costs. Employers should focus on clear communication, proactive planning, and highlighting the value of benefits like HSAs and FSAs.

Key strategies include:

  • Plan communications early (3–4 months in advance) so employees have time to ask questions and compare options.

  • Host webinars or in-person sessions to walk through plan details and answer questions directly.

  • Provide comparison tools and cost calculators that make it easier for employees to see the trade-offs between PPOs, HDHPs, and other plan types.

  • Promote cost-saving accounts like HSAs and FSAs to improve employees’ financial wellness. HSAs in particular offer long-term tax advantages and can reduce both employee and employer healthcare spending.

Employers also benefit directly: contributions made to employee HSAs are exempt from payroll taxes, lowering overall costs while helping employees save for future healthcare needs.


Open Enrollment for Brokers

Brokers serve as trusted advisors to employers, helping them balance cost management with employee satisfaction. Open enrollment is a critical moment to reinforce that value by providing timely insights, strategic guidance, and communication support.

Best practices for brokers include:

  • Review plan performance from the prior year to highlight cost trends, employee utilization, and opportunities for adjustment.

  • Stay updated on legislative or insurance changes, such as the OBBB expansion of HSA eligibility in 2026, so employers remain compliant and competitive.

  • Equip HR teams with communication templates, guides, and FAQs to simplify employee education.

  • Support benefits fairs (virtual or in-person) to drive awareness and provide employees with direct access to experts who can answer their questions.

By preparing early and offering hands-on support, brokers can deepen client relationships, differentiate their services, and position themselves as long-term strategic partners during open enrollment and beyond.


Making the Most of Open Enrollment

Open enrollment may seem complicated, but it doesn’t have to be. With the right questions and preparation, you can make confident choices that protect both your health and your wallet.

By approaching enrollment with a clear sense of your healthcare needs, financial priorities, and long-term goals, you can select benefits that truly fit your life. Whether that means exploring an HSA for tax savings, adjusting coverage for your family, or simply confirming your current plan still works, thoughtful preparation pays off.

With the right plan in place, you’ll have more confidence, fewer surprises, and benefits that help protect both your health and your budget in the year to come.



Disclaimer: the content presented in this article are for informational purposes only, and is not, and must not be considered tax, investment, legal, accounting or financial planning advice, nor a recommendation as to a specific course of action. Investors should consult all available information, including fund prospectuses, and consult with appropriate tax, investment, accounting, legal, and accounting professionals, as appropriate, before making any investment or utilizing any financial planning strategy.

Frequently Asked Questions (FAQ)

What is open enrollment?

Open enrollment is the period each year when you can sign up for, change, or cancel your health insurance and related benefits. During this time, you can review your coverage, compare plans, and make updates for the year ahead. Outside of open enrollment, changes are only allowed if you qualify for a Special Enrollment Period.

Open enrollment for 2025 Marketplace coverage runs from November 1, 2024 through January 15, 2025. To have your coverage begin on January 1, 2025, you must enroll by December 15, 2024. Employer-sponsored plans may have different open enrollment dates, so check with your HR department for exact timelines.

Medicare open enrollment happens every year from October 15 to December 7. During this time, people with Medicare can change their health or prescription drug coverage for the following year. Any changes made during this period take effect on January 1 of the next year.

ACA open enrollment, also called Marketplace open enrollment, runs from November 1, 2024 through January 15, 2025 for the 2025 plan year. If you want coverage to begin on January 1, 2025, you must enroll by December 15, 2024. Some states with their own exchanges may set different enrollment deadlines.

If you miss open enrollment, you generally cannot make changes to your health insurance until the next year. Your current plan may auto-renew, but costs, networks, or coverage could change. The only exception is if you qualify for a Special Enrollment Period due to a life event such as marriage, childbirth, or loss of coverage.

Anyone eligible for health insurance through their employer, the federal Marketplace, or a state exchange can participate during open enrollment. This includes employees, individuals shopping on healthcare.gov, and dependents such as spouses or children. Medicare has its own open enrollment window each fall, which is separate from Marketplace or employer coverage.

Yes, but only if you qualify for a Special Enrollment Period (SEP). SEPs allow you to enroll or change coverage outside of open enrollment if you experience a qualifying life event, such as marriage, divorce, childbirth, moving to a new state, or losing other health coverage.

During open enrollment, you can choose or update a wide range of benefits. These include medical insurance, dental and vision coverage, life and disability insurance, and savings accounts for healthcare expenses like HSAs or FSAs. Some employers also offer commuter, wellness, or lifestyle spending benefits.

To prepare for open enrollment, review your healthcare use from last year, compare costs of premiums and deductibles, and check if your doctors are in-network. Consider life changes like starting a family and evaluate tax-advantaged options like HSAs and FSAs. Planning ahead helps you choose the coverage that best fits your health and budget.

In 2026, the One Big Beautiful Bill (OBBB) expands who qualifies for Health Savings Accounts (HSAs). People enrolled in ACA Bronze and Catastrophic plans will be eligible for HSAs, and telehealth and direct primary care will remain HSA-compatible. These updates give both individuals and employers more options for managing healthcare costs.