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At First Light Financial LLC, we help our clients take a comprehensive view of their finances. One of those components is healthcare. The Marketplace Open Enrollment for health insurance begins on November 1 and runs to January 15.

During that window, you can change healthcare plans or make updates to your current plan. If you are done making updates by December 15, your new coverage will begin on January 1. If you finish open enrollment after December 15, it will start on February 1.

Navigating open enrollment can seem daunting at first glance, so today we’ve put together a guide with information and frequently asked questions to make it easier on you as a healthcare shopper!

What Is Open Enrollment?

First, the basics: Marketplace Open Enrollment refers to the ability of insurance holders to change or update their current health plans, or buy healthcare for the first time, in compliance with the Affordable Care Act (ACA) – which is still the federal standard. Some states have different rules for open enrollment, so click here to see if your state falls outside the norm. For the vast majority of readers, however, this information will be relevant and timely.

If you are employed by a company or government entity, they are likely to have additional resources and tutorials available for open enrollment, so please consult with HR or the financial department at your job for any occupation or company-specific information as well.

According to Newsweek, enrollment reached a record high last year for coverage this year, with more than 24.3 million people signing up for coverage in markets nationwide – so you’re not alone in this process! In the same article, Newsweek reports that premiums are expected to rise by an average of 22% due to inflation and the high number of participants. So, as you start the process of looking around at coverage, be aware that costs get higher each year, and 2026 is seeing a particularly rapid increase. This added expense may mean you need to rethink some of your portfolio to cover medical-related costs, and a First Light Financial LLC Advisor can help you review your personal numbers and make recommendations for how to most effectively allocate your resources.

Please note that if you are privately insured through your employer, the open enrollment period may differ from the November 1 – January 15 window for government insurance. First Light Financial LLC is here any time to help you navigate your specific plan.

Comparing Open Enrollment Plans

Medicare has an interactive plan finder tool available here to allow you to filter through various coverage and determine what is best for you and your family. If you are privately insured through your workplace, your provider will have similar tools on your website.

Someone from the administrative office at your job can help you, or you can speak with a First Light Financial LLC advisor today to help you compare plans. Your State Health Insurance Assistance Program (SHIP) can help you compare options in your specific state, since healthcare markets differ greatly once you cross state lines.

Important Factors to Consider When Choosing a Health Plan

Make sure you can keep your currently preferred doctors and establishments.

If you are changing insurance companies entirely or updating your current plan within your existing provider’s structure, consult with your representative to ensure that you can continue seeing the doctors and medical facilities that you prefer. In-network coverage is important to consider when choosing insurance. While plans like PPOs may allow you to see specialists and out-of-network doctors without referrals or added costs, other plans do not afford the same flexibility. If keeping a current doctor is important to you, that should be a main consideration when choosing your new insurance coverage.

Should You Consider a High-Deductible Health Plan (HDHP)?

You could also consider a high-deductible health plan (HDHP), which has a higher annual deductible (the dollar amount you pay out-of-pocket before your health insurance covers costs) but a lower monthly premium (the monthly fee you pay your provider for coverage). According to Time’s article here, many HDHP plans fully cover in-network preventive care before you even hit your deductible, so you don’t need to pay for medical service like routine annual checkups.

Consider Dependents During Open Enrollment

Open enrollment is the time to add or subtract dependents from your plan. If you’ve had a baby in the last year, they will need to be added to your plan. Likewise, if you had an adult child move out of the house and purchase their own health coverage in 2025, you can safely remove them from your current coverage after consulting with a specialist to ensure your bases are covered. Depending on which hypothetical applies to you, this change could either increase or decrease premiums and out-of-pocket costs, so keep your dependent information as accurate as possible.

If You Are Getting a New Job, You Might Be Able to Enroll Right Away

At most companies, new employees don’t need to wait for open enrollment the following year before securing healthcare benefits. It is in the best interest of everyone for as many people to carry coverage as possible, so both private and public entities want you to carry coverage. If you are new at a job, look into enrolling in healthcare immediately: no need to wait.

What to Have Ready Before You Enroll

If you are making changes during open enrollment, you will need to have the name, address, social security number, birth date, and proof of citizenship or legal residency ready for each covered individual. Depending on your plan, you may also need to pay for your first month’s premium, so be prepared for that extra cost.

Remember: You Don’t NEED to Change Anything!

If you are happy with your current plan, coverage, and medical care teams, you may not need to change anything at all about your insurance. You will be notified by your provider or your workplace if changes are needed or if plans are forcing you to update coverage or amounts, but if not, you can continue on with your current coverage.

Steps to Take Before Open Enrollment Begins

As Fidelity writes here, there are a few things you can do before enrollment to make the process smoother.

Review Coverage and Costs from Last Year

Calculate your out-of-pocket expenses and premiums from 2025 to help develop a comprehensive look at what you spend on healthcare on average, and what you can expect to spend with increasing costs in 2026.

Consider a Health Savings Account

The HSA allows you to put aside money pre-tax for medical expenses both routine and unexpected in the future.

Give Yourself a Deadline

As Fidelity rightly points out, having a self-imposed deadline to enroll and make changes allows you to effectively plan for your coverage needs over time and prevents last-minute rushes to make changes against the deadline. Ideally you want to be all done with the enrollment process by December 15 so that your coverage is active when the clock strikes midnight on the new year. It can take time to get answers from specialists and your coverage team, so bake some extra time into your schedule to hear back on any specific inquiries you might make.

How Do I Enroll in Healthcare Coverage for 2025?

If you’d like to enroll or make changes online, you can start by visiting https://www.healthcare.gov/ for publicly available insurance or your provider’s website for private plans. As aforementioned, your workplace is also a resource for getting in touch with provider representatives or even making changes to your plan directly through a coverage section on your company portal or intranet. You can also enroll or make changes over the phone, in-person with an enrollment specialist, or via paper application in the mail.

What Types of Insurance are Available for Purchase?

Fidelity has a good open enrollment guide here where they detail some of the different coverage types you can add during open enrollment – from dental and vision to life, disability, and pet insurance. Some programs offer added perks like identity and data protection and a flexible spending account (FSA), which allows you to stock up money pre-tax for medical expenditures according to a “use it or lose it” rule where unspent funds are forfeited at year’s end.

What Types of Insurance Don’t Offer Open Enrollment?

If you are covered by Medicaid, a limited income federal insurance coverage, there is no open enrollment period – same for the Children’s Health Insurance Program (CHIP). A First Light Financial LLC advisor can help you determine if your coverage participates in open enrollment, if you need help.

Missed Open Enrollment?

Try not to miss open enrollment, but if you do you might have options. Any qualifying life event throughout the year like a new medical diagnosis, a move, or a legal status change may allow you to re-enroll outside the open enrollment period. Healthinsurance.org has a guide to special enrollment periods available here.

As alluded to earlier, participants in Medicaid, CHIP, and American Indian and Alaskan Native individuals can sign up for coverage year-round. A First Light Financial LLC advisor can help you parse through these nuances and decide when it is best to enroll for you.

Changes to Medicare

Medicare is a publicly available health insurance coverage system for adults aged 65 and older and folks with disabilities. Kiplinger has published a handy guide here on incoming changes to Medicare and how you should respond. Here are the highlights:

Coverage Restrictions for Medicare Advantage

Medicare Advantage (also known as Part C), is a privately offered Medicare alternative to other plan types. Additional benefits like prescription drug coverage are often included. Medicare Advantage is expected to scale back some aspects of the program, like benefits, as well as increase costs to keep pace with higher costs to provide service in the industry. Prior authorization may be required to obtain certain types of treatments in some states. Since you are able to choose between original Medicare and Medicare Advantage, it is worth taking a look at coverage changes in your market and assessing your plan accordingly. Medicare is often more expensive than Advantage, but with new hoops to jump through for individuals with Advantage, it may be the better choice. Your insurer should be sending you an Annual Notice of Change detailing any changes to your coverage.

Higher Premiums Expected in 2026

Monthly premiums for various Medicare plans are expected to jump in 2026. The income-related monthly adjustment amount, which accounts for higher income retired and elderly individuals, is also expected to go up. Comparing prices for different plans is the best way to attack this particular change.

Changing Prescription Medication Costs

The out-of-pocket annual cap you pay on prescription medications will go up by $100 in 2026, for a new cap of $2,100. Kiplinger reports in their article that certain popular prescriptions like blood thinners will see discounts of 38-79%, so you may save money in the long run depending on the drug portfolio that you utilize. The bottom line here: compare, compare, compare. Medication costs and what is covered vs. what you pay out of pocket varies from plan to plan, so do a thorough read-through of your various options and consider connecting with a First Light Financial LLC advisor to help you assess.

According to the Centers for Medicare & Medicaid Services here, 97% of public healthcare shoppers will have access to at least three health insurance issuers – which is a 96% jump from last year. Options are available, so do your due diligence and shop around!

Let Us Help You Choose the Best Plan!

While it is outside the scope of this article besides what we briefly touched on with Medicare, there is expiration planned for ACA-related enhanced subsidies at the end of this year. We encourage you to research these and connect with a First Light Financial LLC advisor to walk you through what these changes could mean for your health coverage. Here at First Light Financial LLC, we’re committed to helping you build a comprehensive holistic personal financial portfolio, including coverage for unexpected or routine medical coverage and healthcare costs. Our advisors are highly trained in various ACA-compliant programs and can answer your questions. Please visit our website today to begin your journey with First Light Financial LLC!

Navigating 2025 Open Enrollment: A Financial Advisor’s Guide to Smarter Healthcare Choices