Open enrollment has a way of turning a major financial decision into a monthly-price contest. One plan costs less per paycheck. Another has a higher premium. The natural reaction is to choose the option that feels cheaper.
But health coverage is not priced in one number. It is priced in layers: what you pay every month, what you pay before the plan starts sharing costs, what you pay at the pharmacy, what happens when you see a specialist, and how much financial exposure remains if the year becomes medically expensive.
For people shopping through the federal Marketplace, Open Enrollment for 2027 coverage starts November 1, 2026. HealthCare.gov says December 15 is the deadline for coverage that begins January 1, and January 15 is the final day of the annual Open Enrollment Period. Employer plan windows can be different, so the best preparation starts before the enrollment portal opens.
1. The Premium: What You Pay to Keep the Plan
The premium is still important. It is the fixed cost you agree to pay for coverage, whether you use the plan heavily or barely at all. The mistake is treating it as the entire price.
Convert the premium into an annual figure. If a plan costs $180 per paycheck and you are paid twice a month, that is $4,320 a year before deductibles, copays, prescriptions or coinsurance enter the picture. That annual number makes it easier to compare a higher-premium plan with richer benefits against a lower-premium plan with more out-of-pocket exposure.
Never compare monthly premiums alone. Put annual premium, deductible and out-of-pocket maximum on the same page.
2. The Deductible: What You May Pay Before Cost-Sharing Improves
The deductible tells you how much covered care you may have to pay for before the plan begins paying more of the bill, although some services can be covered before the deductible depending on the plan.
Ask a practical question: if you had to satisfy the deductible in the first three months of the year, could your cash reserves handle it without creating new credit-card debt?
For 2027, IRS rules define an HSA-qualified high-deductible health plan as having a deductible of at least $1,750 for self-only coverage or $3,500 for family coverage. Those thresholds matter if an HSA is part of your strategy, but the deductible printed on a specific plan can be higher.
3. The Out-of-Pocket Maximum: Your Worst-Case In-Network Number
This is one of the most important numbers on the page because it helps frame the upper end of what a difficult medical year could cost for covered in-network care, excluding premiums and subject to the plan's rules.
For 2027 HSA-qualified high-deductible plans, the IRS says annual out-of-pocket expenses cannot exceed $8,700 for self-only coverage or $17,400 for family coverage. Those are federal HSA-plan limits, not a promise that every health plan will use those exact amounts.
When comparing plans, combine annual premiums with the out-of-pocket maximum. That is not a perfect forecast, but it gives you a useful stress-test number.
4. Copays: The Cost of Routine Use
Copays can matter more than the deductible for households that regularly use primary care, urgent care, therapy, specialists or prescriptions. A plan with a lower premium may charge more every time you access care.
Look at the services your household actually used during the last 12 months. Count primary-care visits, specialist appointments, therapy sessions and urgent-care visits. Then apply the new plan's copays to that real usage pattern.
This turns an abstract benefits sheet into a household-specific estimate.
5. Coinsurance: The Percentage That Can Surprise You
Coinsurance is the share of a covered service you pay after the applicable deductible, usually expressed as a percentage. Twenty percent may not sound dramatic until it is attached to a large procedure, imaging bill or outpatient service.
Do not stop at the percentage. Ask what services use coinsurance, whether the deductible applies first, and whether those services are likely for anyone in your household next year.
6. Prescription Costs: Check the Drugs, Not Just the Drug Benefit
Two plans can both advertise prescription coverage and still produce very different annual costs. Formularies, tiers, deductibles, copays, coinsurance and preferred pharmacies can all change what a medication costs.
Before enrollment, make a list of current prescriptions by exact drug name and dosage. Check each plan's formulary and pharmacy rules. If a medication is expensive or ongoing, this step can matter more than a modest premium difference.
7. HSA Support: The Employer Contribution and the 2027 Limit
If you are eligible for a Health Savings Account, do not evaluate the health plan without evaluating the HSA economics. Employer contributions effectively reduce what the plan costs you, while your own HSA contributions can create additional tax advantages when eligibility requirements are met.
The IRS set the 2027 HSA contribution limit at $4,500 for self-only coverage and $9,000 for family coverage. That total generally includes contributions from all sources, including employer deposits. If an employer contributes $1,000, for example, that is real value that belongs in the plan comparison.
People age 55 or older may have access to an additional HSA catch-up contribution under current law; confirm the rules that apply to you before contributing.
Build a One-Page Plan Scorecard
Before choosing coverage, put every finalist into the same seven-line scorecard:
- Annual premium: your full-year payroll or Marketplace cost.
- Deductible: individual and family, if applicable.
- Out-of-pocket maximum: individual and family.
- Copays: primary care, specialist, urgent care and therapy.
- Coinsurance: especially imaging, outpatient care and hospital services.
- Prescription costs: based on the medications you actually use.
- HSA value: employer contribution plus your planned contribution, if eligible.
Then add two non-numeric checks: whether your doctors and hospitals are in network, and whether the plan covers the services or medications you expect to use.
The Bottom Line
Open enrollment is not a search for the cheapest plan. It is a search for the best financial fit between predictable costs, potential exposure and the way your household uses care.
The premium gets your attention because it is visible every month. The other six numbers determine whether that premium was actually a good deal.
Editorial note: This article is for general financial education. Health-plan, tax and HSA decisions should be evaluated using current plan documents, official guidance and your personal circumstances.