Compare and enroll in a health insurance plan by understanding open enrollment dates, plan tiers, premium-deductible tradeoffs, provider networks, prescription coverage, and subsidy eligibility.
Mark the Marketplace open enrollment period (typically November 1 through January 15)
The federal Marketplace open enrollment runs November 1 through January 15 annually. Some states run their own exchanges with different dates. Missing enrollment means waiting until next year unless you qualify for a Special Enrollment Period.
Check your employer's open enrollment dates if you have employer coverage
Employer open enrollment usually runs 2-4 weeks in the fall (October-November) for January 1 start dates. Missing your employer's window locks you into your current plan for another year unless you have a qualifying life event.
Know which life events trigger a Special Enrollment Period (SEP)
Qualifying events include job loss, marriage, divorce, having a baby, moving to a new state, or losing other coverage. A SEP gives you 60 days from the event to enroll outside the normal window. Keep documentation of the qualifying event.
Start comparing plans at least 2 weeks before the enrollment deadline
Rushing plan selection on the last day leads to poor choices. Plans change premiums, networks, and formularies annually. A plan that worked last year may have dropped your doctor or increased costs. Give yourself time to compare properly.
Bronze plans cover about 60% of costs on average. Monthly premiums run $200-$400 for an individual. Deductibles are high ($6,000-$8,000). Best for healthy people who rarely see a doctor and want catastrophic protection at the lowest monthly cost.
Silver plans cover about 70% of costs. Premiums run $350-$550 monthly. Deductibles are $2,000-$5,000. Silver plans are the only tier eligible for cost-sharing reductions (CSR) for incomes below 250% of the federal poverty level, making them the best value for many people.
Gold plans cover about 80% of costs. Premiums run $450-$700 monthly. Deductibles are $500-$1,500. If you visit the doctor frequently, take multiple medications, or have a planned surgery, Gold plans often cost less overall despite higher premiums.
Platinum plans cover about 90% of costs with premiums of $600-$900 monthly and deductibles of $0-$500. Best for people with chronic conditions requiring frequent specialist visits and expensive medications. Not available in all markets.
Evaluate Premium vs Deductible Tradeoff
Calculate your expected annual healthcare spending based on last year
Add up last year's doctor visits, prescriptions, lab work, and procedures. If you spent $1,500 out of pocket, that's your baseline. A healthy 30-year-old with no conditions might spend $500-$1,000. A family with a chronic condition might spend $5,000-$10,000.
Compare total annual cost: (monthly premium x 12) + expected out-of-pocket expenses
A Bronze plan at $300 per month with $3,000 in expected out-of-pocket costs totals $6,600. A Gold plan at $550 per month with $500 out-of-pocket totals $7,100. The $500 difference may be worth the Gold plan's predictability and lower risk if something unexpected happens.
Check the annual out-of-pocket maximum for each plan
The 2024 federal out-of-pocket maximum is $9,450 for individuals and $18,900 for families. This is your worst-case annual expense beyond premiums. If the worst case of a Bronze plan ($9,450) versus Gold ($5,000) matters to your budget, choose Gold for protection.
Model a worst-case scenario (surgery, hospitalization, or serious diagnosis)
A 3-day hospital stay costs $10,000-$30,000 before insurance. On a Bronze plan with a $7,000 deductible, you'd pay $7,000+. On a Gold plan with a $1,000 deductible, you'd pay about $1,000-$3,000. If you can't absorb $7,000 suddenly, higher-tier plans provide financial protection.
Check Provider Networks and Prescriptions
Verify that your current doctors are in-network for each plan you're considering
Out-of-network visits cost 2-5 times more than in-network. Use each plan's online provider directory to search for your primary care doctor, specialists, and preferred hospital. Call the provider's office to double-check—directories can be outdated.
Understand the difference between HMO, PPO, and EPO network types
HMO: must use in-network providers and get referrals for specialists (cheapest premiums). PPO: can see any provider but pay less in-network, no referrals needed (most flexible, highest premiums). EPO: in-network only but no referrals needed (middle ground).
Check that your current prescriptions are on the plan's formulary
Each plan has a drug formulary with tiers: generic ($5-$20 copay), preferred brand ($30-$60), non-preferred brand ($75-$150), and specialty ($200+). A medication on Tier 2 in one plan might be Tier 4 in another—same drug, very different cost.
If you have a specialist or therapist, confirm they're in-network
Switching mid-treatment to a new specialist due to an insurance change is disruptive. A cardiologist or therapist you've been seeing for years has valuable context on your health. Keeping continuity of care is worth prioritizing in plan selection.
Check HSA Eligibility
Determine if any plans qualify as a High-Deductible Health Plan (HDHP) for HSA eligibility
For 2024, an HDHP must have a deductible of at least $1,600 (individual) or $3,200 (family), with an out-of-pocket max of $8,050 (individual) or $16,100 (family). Most Bronze and some Silver plans qualify. Check the plan details carefully.
Understand the triple tax advantage of an HSA
HSA contributions are tax-deductible ($4,150 individual, $8,300 family for 2024), growth is tax-free, and withdrawals for medical expenses are tax-free. No other account offers all three. A $4,150 contribution in the 22% bracket saves $913 in taxes immediately.
Consider using an HSA as a long-term investment vehicle
You can invest HSA funds in index funds and let them grow for decades. After age 65, HSA withdrawals for any purpose are taxed like a Traditional IRA (no penalty). Paying current medical expenses out of pocket and letting the HSA grow invested is a powerful retirement strategy.
Calculate Subsidy Eligibility and Enroll
Check if your household income qualifies for a premium tax credit
Premium tax credits are available for incomes between 100% and 400% of the federal poverty level ($14,580-$58,320 for an individual in 2024). Enhanced subsidies through the Inflation Reduction Act cap premiums at 8.5% of income for those above 400% FPL.
Calculate your expected subsidy amount using the Marketplace estimator tool
A 35-year-old earning $40,000 might receive a subsidy of $200-$400 per month depending on location, reducing a $500 Silver plan to $100-$300 per month. The subsidy is based on the benchmark Silver plan cost in your area.
If income is under 250% FPL, select a Silver plan for cost-sharing reductions
Cost-sharing reductions (CSR) lower deductibles, copays, and out-of-pocket maximums on Silver plans only. At 150% FPL, a Silver plan's deductible might drop from $4,000 to $200 and the out-of-pocket max from $8,000 to $2,500. CSR savings can be worth $3,000-$5,000 per year.
Complete enrollment by the deadline and save your confirmation with plan ID and effective date
Print or screenshot your enrollment confirmation showing the plan name, ID number, effective date, and monthly premium. Set up autopay for premiums immediately—missing your first premium payment by the due date can cancel your coverage before it even starts.
Frequently Asked Questions
When is open enrollment for health insurance?
ACA Marketplace runs November 1 through January 15 annually (check healthcare.gov for exact dates). Employer plans typically open in October-November for January 1 start. Missing it means waiting unless you qualify for a Special Enrollment Period triggered by marriage, birth, job loss, or moving within 60 days of the event.
What is the difference between HMO, PPO, and HDHP plans?
HMOs require referrals and limit coverage to in-network providers but have lower premiums. PPOs allow any provider without referrals (out-of-network costs more) with the most flexibility. HDHPs have lowest premiums but highest deductibles ($1,600+ individual) and are the only plans qualifying for HSA contributions. Healthy individuals who rarely see specialists often save with HDHPs.
How do I know if I qualify for an ACA subsidy?
Premium tax credits are available for households earning 100-400% of the Federal Poverty Level (roughly $14,580-$58,320 individual, $30,000-$120,000 family of four in 2024). Enhanced subsidies cap premiums at 8.5% of income regardless of earnings. Check eligibility at healthcare.gov. Amounts change annually based on income, family size, and local benchmark premiums.
What does out-of-pocket maximum mean?
The most you pay for covered in-network services in a plan year, including deductibles, copays, and coinsurance. For 2024, ACA caps this at $9,450 individual and $18,900 family. After hitting it, the plan pays 100% for the rest of the year. Premiums, out-of-network services, and non-covered items do not count toward this limit.