Open Enrollment is your annual opportunity to review your health insurance and decide whether your current coverage still fits your needs and budget. With premiums, provider networks, deductibles, and benefits changing from year to year, simply renewing the same plan may not always be the best approach.
One important part of shopping for coverage is understanding that not every type of health plan works the same way. Two options you may encounter are Affordable Care Act (ACA) Marketplace plans and fixed benefit health insurance plans.

Marketplace Health Insurance

Marketplace plans are comprehensive major medical insurance. They cover the ACA’s essential health benefits, including hospitalization, emergency services, prescription drugs, preventive care, and maternity care. They also cannot deny coverage or charge you more because of a pre-existing condition.
Depending on your household income and other eligibility factors, you may qualify for financial assistance that reduces your monthly premium. Some consumers may also qualify for additional savings on deductibles, copayments, and other out-of-pocket costs when enrolled in an eligible Marketplace plan.
When comparing Marketplace plans, don't look at the premium alone. Consider the deductible, maximum out-of-pocket limit, prescription drug coverage, provider network, and whether your doctors and preferred hospitals participate.

What About Fixed Benefit Health Insurance?

Fixed benefit plans work differently. Instead of functioning like comprehensive major medical insurance, these plans generally pay predetermined dollar amounts for covered medical events or services. For example, a plan might pay a specified amount for a hospital stay, physician visit, or other covered service.
These plans can sometimes have lower monthly premiums, which may make them attractive to people primarily focused on monthly cost. However, the tradeoff can be significant. If the plan's scheduled benefit is less than the provider's bill, you may be responsible for the remaining balance. Coverage for prescriptions, preventive services, pre-existing conditions, and other healthcare needs can also differ substantially from comprehensive Marketplace coverage.
For that reason, it's important to understand exactly what you're purchasing rather than assuming that two products advertised as "health insurance" provide comparable protection.

Compare the Whole Picture

 

During Open Enrollment, ask yourself: How often do I use healthcare? Are my doctors in-network? What prescriptions do I take? Could I comfortably handle a large unexpected medical expense? Am I eligible for Marketplace financial assistance? There isn't one health plan that fits every person or family. The goal should be to understand the premiums, benefits, limitations, provider access, and potential out-of-pocket exposure before enrolling.

If you're uncertain, consider working with a licensed health insurance broker who can explain your available options and help you compare how different types of coverage could work in real-world situations. A little extra comparison during Open Enrollment can help you make a more informed decision for the year ahead.