Open Enrollment Preparation: What to Review Before Choosing a Plan

Insurance Basics Editorial Team Staff Writer · Sep 24, 2025 · 6 min read

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A practical checklist of the information, documents, and questions you should work through before locking in your health coverage for the year.

Key Takeaways

Reviewing your current plan's performance before open enrollment helps you spot coverage gaps early.
Knowing your expected healthcare needs for the coming year is essential before comparing plans.
Total annual cost matters far more than the monthly premium alone.
Confirming your doctors and prescriptions are covered under a new plan prevents unexpected out-of-pocket costs.
Life changes — marriage, a new baby, job switch — may qualify you for a special enrollment period outside the standard window.

Why Preparation Makes the Difference

Open enrollment typically lasts only a few weeks, but the plan you choose affects your healthcare access and household budget for the entire following year. Many people default to auto-renewing their existing plan without realizing premiums, deductibles, formularies, or provider networks may have changed since they last enrolled.

This checklist walks you through every category of information worth reviewing before you make a selection. Think of it as a pre-flight check — not to overwhelm you, but to make sure nothing important gets overlooked. For a deeper look at what to examine once you're comparing specific options, see our article How to Evaluate a Health Plan Beyond the Monthly Premium.

This article provides general educational information about health insurance and is not personalized insurance, financial, or legal advice. Coverage terms vary by insurer, employer, and state. Always review your actual plan documents and consult a licensed insurance agent or adviser for decisions specific to your situation.

Auto-Renewal Doesn't Mean Nothing Changed

If you don't actively choose a plan during open enrollment, most employers and marketplace exchanges will automatically re-enroll you in your current plan — but the plan's terms may have changed. Premiums often increase, drug formularies are updated, and provider networks shift annually. Assuming your existing coverage is identical to last year can lead to surprise costs. Always review the renewal notice before the deadline.

Gather These Documents and Records First

Before you can make a meaningful comparison, you need the right raw material. Pull these together in one place before the enrollment window opens.

Required

Last Year's EOB Statements

Show what your plan paid versus what you owed, revealing how you actually used your coverage.

Required

Current Plan's Renewal Notice

Details any changes to your premium, deductible, copays, or network for the coming plan year.

Required

Complete Medication List

Needed to cross-check each plan's drug formulary and identify any coverage gaps or tier changes.

Required

Provider Directory (from each insurer)

Confirms whether your current doctors, hospitals, and specialists are in-network under each plan you're considering.

Required

Summary of Benefits and Coverage (SBC)

A standardized two-page document insurers must provide that makes plan comparison straightforward.

Optional

Healthcare Spending Estimate Worksheet

Helps you project your total annual out-of-pocket costs under different plan scenarios.

Work Through the Checklist

Use the groups below as a structured guide. Work through each category in order — your findings in one section will inform the questions you ask in the next.

Assess Your Current Plan's Performance

Review your Explanation of Benefits (EOB) statements from the past year to see what you actually paid versus what was covered. Must

Note any services you needed but found were not covered or required prior authorization that caused delays. Must

Check whether your deductible, out-of-pocket maximum, or copays changed from last year on your current plan's renewal notice. Must

Confirm whether your primary care physician and any specialists you see regularly are still in-network for the coming plan year. Must

Estimate Next Year's Healthcare Needs

List any planned or anticipated procedures, specialist visits, imaging, or therapies for the coming year. Must

Write down every prescription medication you take regularly, including dosage and frequency, to verify formulary coverage. Must

Account for any expected life events — pregnancy, surgery, a child aging off a parent's plan — that will increase healthcare use. Should

Consider mental health or substance use treatment needs, which are legally required to be covered comparably to medical benefits under federal parity rules. Should

Understand the Cost Structure

Calculate your total estimated annual cost by adding projected premium payments to your likely out-of-pocket spending, not just the monthly premium. Must

Identify each plan's deductible (the amount you pay before coverage kicks in), copay amounts, coinsurance percentages, and out-of-pocket maximum. Must

Determine whether a plan's deductible is individual or family-level, since these work differently when covering multiple household members. Should

Check whether a Health Savings Account (HSA) is available with any high-deductible plan option and whether your employer contributes to it. Nice to have

Verify Network and Drug Coverage

Look up each plan's provider directory — available from the insurer — and confirm your doctors, hospitals, and labs are listed as in-network. Must

Search each plan's drug formulary for every medication on your list and confirm the tier level and any quantity or step-therapy restrictions. Must

Check whether specialist referrals are required (HMO model) or whether you can self-refer (PPO model), and decide which fits your healthcare habits. Should

Account for Life Changes and Special Situations

Confirm whether any qualifying life events in the past year — marriage, divorce, birth, adoption, job change — affect your eligibility or enrollment window. Must

If you have dependents, verify that all family members are listed correctly and that their providers are also in-network under the plan you're considering. Must

Review whether you qualify for premium tax credits or cost-sharing reductions through the Health Insurance Marketplace based on your household income. Should

Final Review Before Submitting

Read the Summary of Benefits and Coverage (SBC) document for each finalist plan — insurers are required to provide this standardized summary. Must

Double-check that all personal information — name spelling, date of birth, Social Security number — is entered correctly on the enrollment form. Must

Note the enrollment deadline in your calendar and confirm your first premium payment date so coverage does not lapse. Must

Don't Choose Based on Premium Alone

A plan with a lower monthly premium often carries a higher deductible, meaning you'll pay more out-of-pocket before coverage begins. If you anticipate regular medical visits, prescriptions, or any procedures, a slightly higher premium with a lower deductible may cost you less overall. Run the numbers for your specific expected usage before deciding.

Out-of-Network Costs Can Be Substantial

Seeing a provider outside your plan's network — even accidentally, such as receiving care from an out-of-network specialist at an in-network facility — can result in significantly higher bills. Verify network status directly with the insurer and your provider's office before your first appointment under a new plan.

Once you've completed the health coverage review, it may also be a useful moment to check other household policies for gaps. Our Reviewing Your Insurance Coverage household checklist covers life, disability, and renters insurance in a similar structured format.

If you want to get more value from whichever plan you choose, planning your preventive care in advance is a practical next step — see Scheduling a Year's Worth of Preventive Appointments Without the Overwhelm for a walkthrough.

Insurance Basics Editorial Team

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Insurance Basics Editorial Team is the collective byline for our editorial team and contributor network. Articles published under this byline or an editorial pen name are researched, written, and reviewed according to our editorial standards for clarity, consistency, and independence before publication.

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