How to pick a health insurance plan during open enrollment

Open enrollment usually gets twenty minutes: a glance at three premiums, a click on the middle one, done. Then in March a $1,200 MRI arrives and the plan pays nothing, because the deductible hasn't been met. The premium is only the price of admission. The real cost of a plan is what you pay for it plus what you pay while using it.

Know the five numbers on every plan

• Premium. What you pay every month, whether or not you see a doctor.
• Deductible. What you pay for most care before the plan starts sharing costs.
• Copays and coinsurance. Your share after the deductible: a flat $30 visit, or 20% of a bill.
• Out-of-pocket maximum. The most you pay for covered in-network care in a year. For 2027, ACA-compliant plans can set it no higher than $12,000 for one person and $24,000 for a family, up from $10,600 and $21,200 in 2026.
• Network. Which doctors, hospitals and labs count as in network. Out of network, the maximum may not protect you.

Compare plans by their worst year and their typical year, never by the premium alone.

Estimate your real year from last year's EOBs

Your Explanation of Benefits statements show what each visit actually cost. Pull last year's and add up:

1. Visits: primary care, specialists, therapy, urgent care.
2. Prescriptions: each drug and how often you fill it.
3. Big events: imaging, surgery, a birth, an ER trip.

Then run the math for each plan in two scenarios.

• Typical year: 12 × premium + what last year's care would cost under that plan's deductible and copays.
• Bad year: 12 × premium + the out-of-pocket maximum.

Example: Plan A costs $450 a month with a $1,500 deductible; Plan B costs $300 a month with a $5,000 deductible. Plan B saves $1,800 in premiums. If you rarely use care, B wins. If you expect to hit the deductible, A's lower deductible covers that gap and then some. Our guide to reading an EOB before you pay explains every line on those statements.

Check the network and the drug list

• Look up each must-keep doctor and hospital in the plan's directory, then call the office to confirm they take that exact plan next year.
• Search the formulary for every prescription. Note the tier, and whether it needs prior authorization or step therapy.
• Check your pharmacy is in network, and whether mail order is cheaper for daily medicines.

Decide whether an HSA plan fits

A health savings account lets you put money aside tax-free for medical costs, but only with an HSA-eligible plan. For 2027 the contribution limit is $4,500 for self-only coverage and $9,000 for a family, plus $1,000 if you're 55 or older. Starting in 2026, bronze and catastrophic Marketplace plans also count as HSA-compatible. An HSA plan suits people with savings to cover the deductible; the money rolls over year to year. IRS Publication 969 has the rules.

Mind the deadline. On HealthCare.gov, open enrollment for 2027 runs November 1, 2026 to January 15, 2027, and you need to enroll by December 15 for coverage starting January 1. State marketplaces and employers set their own dates.

To build that estimate, EOB Keeper can help. Scan each EOB and bill with your iPhone camera and it reads the provider, date, codes and amounts on the phone. A ring shows deductible and out-of-pocket progress for each family member, and the HSA folder exports a year of receipts as one PDF. It's free, with no subscription and no account.

An hour with last year's statements now can save you from this year's surprise bill next spring.