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Infographic: Open Enrollment Explained

Infographic explaining open enrollment windows and key plan decisions

Download this infographic to keep as a reference

The Decision Point

Every year, your insurance company sends you a piece of paper that says “Open Enrollment Period.” And every year, most people ignore it. They think: “I’ll just keep the same plan I have.” But here’s what that paper is really saying: “Everything about your health insurance has changed. Your choices, your costs, your doctors, your medications — all of it is different now. You get to decide what to do about that.” This lesson is about making that decision in one hour, not one year.

Three Different Calendars

Open enrollment happens at different times, depending on where you get your insurance.

Marketplace Plans

If you get coverage through the Marketplace — either directly or through your state’s healthcare website — your open enrollment window is November 1 through January 15. That’s ten weeks to enroll, switch plans, or drop coverage. This is where people without employer insurance go. If you get subsidies to help pay for your premium, this is when you recalculate them based on your current income.

Medicare Plans

If you’re on Medicare, your open enrollment window is October 15 through December 7 each year. During this period, you can switch between Medicare Advantage plans and original Medicare, or change your prescription drug coverage. Like Marketplace, your costs may change, your network may change, and your formulary (the list of covered medications) may change.

Employer Plans

If you get insurance through an employer, your open enrollment typically happens in October or November and lasts 30–60 days. You can switch plans, add or drop dependents, or change your coverage tier. Many people don’t realize they have choices here — they think the company picks the plan for them. It doesn’t. You do.

Medicaid is different: Medicaid doesn’t have a single “open enrollment period.” You can apply or change your coverage year-round, based on income changes.

The reason all these windows exist is that insurance costs and coverage change every single year. Your old plan is not your old plan anymore. The network of doctors might have changed. The medications covered might have changed. The premium definitely changed. So every year, you get a decision point. Most people use it to do nothing — they accept the default. But you don’t have to.

The Six Numbers That Matter

When comparing plans, there are six things that actually matter. Here’s the framework:

Premium

Monthly cost

Deductible

What you pay first

Copay & Coinsurance

Your share per visit

Out-of-Pocket Max

The annual ceiling

Network

Which doctors covered

Formulary

Which meds covered

The temptation is to pick the cheapest premium. But the cheapest premium often means a higher deductible. If you have a chronic condition and fill prescriptions regularly, the copay structure matters more than the monthly premium. If you have a specific doctor you want to see, network matters. If you take a specific medication, formulary matters. No single plan wins on all six. You’re trading off.

The HSA Option

A Health Savings Account paired with a high-deductible plan (HDHP) is one option. An HDHP has a deductible of at least $1,600 for individual coverage in 2025. If you go that route, you can open an HSA and put money in it tax-free, grow it tax-free, and withdraw it tax-free for medical expenses. It’s a powerful tool — but only if you have the cash to cover the higher deductible.

Your Five-Step Plan

Here’s your action this week. Build one simple plan comparison sheet. Here’s how:

Get your open enrollment notice. It has a date on it. Know that date. If you’re on Marketplace, you have until January 15. If you’re on Medicare, you have until December 7. If you’re on employer insurance, your company will tell you the window. Write it down.

List your current medications. Go to your medicine cabinet right now. Write them all down. That list is your filter for every plan you consider.

Get your three top plan options. For each one, write down: (1) the monthly premium, (2) the deductible, (3) the copay for your doctor and your prescriptions, (4) the out-of-pocket maximum, and (5) whether your current doctor is in the network.

Check each plan’s formulary. Go to the plan’s website and search for every medication on your list. Write down which tier it’s on. Tier 1 is cheapest, Tier 4 or 5 is most expensive. If a medication isn’t covered, that plan is off the table.

Compare. Is the cheapest plan actually the cheapest when you add up deductible, copays, and out-of-pocket max? Is your doctor in the network? Are your medications covered? If the answer to all three is “yes,” you have a real option.

Need help? Two resources exist:

Your Plan Member Services

The number is on your insurance card. They can walk you through coverage questions and help you understand your options.

Healthcare.gov

Has a plan comparison tool at healthcare.gov/choose-a-plan/compare-plans. Put in your information and it shows you side-by-side comparisons.

Full Lesson Transcript

Beat 1: The Decision Point (Opening)

Every year, your insurance company sends you a piece of paper that says “Open Enrollment Period.” And every year, most people ignore it. They think: “I’ll just keep the same plan I have.” But here’s what that paper is really saying: “Everything about your health insurance has changed. Your choices, your costs, your doctors, your medications — all of it is different now. You get to decide what to do about that.” This lesson is about making that decision in one hour, not one year. Let’s start.

Beat 2: The System (How enrollment works)

Open enrollment is different for everyone. If you get coverage through the Marketplace, your window is November 1 through January 15 — ten weeks to enroll, switch plans, or drop coverage. If you’re on Medicare, your window is October 15 through December 7. If you get insurance through an employer, open enrollment usually happens in October or November and lasts 30 to 60 days. Medicaid is different — there’s no annual window. You can apply or change coverage year-round. The reason these windows exist is that insurance costs and coverage change every single year. Your old plan is not your old plan anymore.

Beat 3: The Evidence (Six comparison factors)

When comparing plans, there are six things that matter. One: the premium, the monthly cost. Two: the deductible, what you pay before the plan starts paying. Three: the copay and coinsurance, your share of each visit or prescription. Four: the out-of-pocket maximum, the ceiling for how much you’ll pay in a year. In 2025, that federal ceiling is $9,100 for individual coverage. Five: the network, which doctors and hospitals your plan covers. And six: the formulary, which medications are covered and at what cost. The temptation is to pick the cheapest premium. But the cheapest premium often means a higher deductible. No single plan wins on all six. You’re trading off.

Beat 4: The Action (Five concrete steps)

Here’s your action this week. Build one simple plan comparison sheet. First, get your open enrollment notice. Second, list your current medications. Third, get your three top plan options and write down the premium, deductible, copay, out-of-pocket max, and whether your doctor is in network. Fourth, check each plan’s formulary and see where your medications are covered. Fifth, compare. Is the cheapest plan actually the cheapest? Is your doctor in the network? Are your medications covered? If the answer to all three is yes, you have a real option. Your plan’s member services line can help you, or use the tool at healthcare.gov.

Beat 5: The Close (Next lesson tease)

Open enrollment isn’t random. It’s the annual decision point where you get to see what’s changed, compare your options, and choose intentionally. Most people ignore it. You’re not going to be most people. You’re going to spend one hour this week with your plan comparison sheet. You’re going to know, not guess. Next lesson, we’ll look at what to do if your claim gets denied. See you there.

Get Your Plan Comparison Template

Download a free worksheet to organize the six factors and compare your plan options side-by-side.

Sources & References

Centers for Medicare & Medicaid Services (CMS). Open Enrollment Period Glossary. Healthcare.gov. Accessed 2025. Key finding: Marketplace open enrollment runs November 1 – January 15 annually; Medicare Annual Enrollment Period runs October 15 – December 7.

CMS / HHS. Special Enrollment Periods. Healthcare.gov. Current guidance on qualifying life events that unlock enrollment year-round.

CMS / HHS. Plan Comparison Framework. Healthcare.gov. Documents the six key factors for evaluating health plans: premium, deductible, copay, out-of-pocket maximum, network, and formulary.

U.S. Internal Revenue Service (IRS). Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans. 2025. Verifies HDHP minimum deductible ($1,600 individual, 2025) and HSA tax advantages.

Kaiser Family Foundation (KFF). Enrollment Experiences and Sources of Confusion Among Uninsured and Newly Insured Adults. 2023. Documents common enrollment mistakes: not reviewing plans annually, overlooking network changes, failing to verify formulary updates.

Centers for Medicare & Medicaid Services (CMS). Out-of-Pocket Maximum Glossary. Healthcare.gov. Confirms 2025 federal OOP max of $9,100 individual, $18,200 family.

Check Your Understanding

Knowledge Check

Priya missed her window to change plans. Her old employer plan no longer covers her GLP-1 medication, so she’s paying $1,100 out of pocket every month. When can she switch plans?

Open enrollment is the ONE window each year to change your plan. Outside of it, the only other door is a Special Enrollment Period triggered by a qualifying life event (job change, marriage, baby, loss of other coverage). Miss it, and you’re locked in until next November. That’s why the open enrollment end date goes on your calendar today.

Do This Now

Pull out your calendar right now and write down your open enrollment end date — for ACA plans it’s January 15; for employer plans it varies. Then list the three medications and one specialist you used most this year. Those five pieces of information are what you’ll compare every plan against this week.

Find out which plan type fits your situation with the Benefits Quiz →

About This Lesson

Course: How Your Insurance Actually Works (Insurance IQ)

Module: 4 · Choosing Your Plan

Lesson: 4.1 · Open Enrollment Playbook

Learning Goal: By the end of this lesson, you will be able to identify your specific open enrollment window, compare insurance plans using six key factors, and make an intentional plan choice before the deadline.

Persona: Maria, making decisions about next year’s coverage

Video Length: 6–7 minutes

Need Help? Discuss this lesson with your healthcare provider or contact your plan’s member services line.

This lesson is part of How Your Insurance Actually Works—an evidence-based course designed with clinical expertise by the AnchorWellPress Medical Team. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult your healthcare provider.