11/04/2025
It’s Open Enrollment Season – Here’s What to Know
Fall brings cooler weather and football games, and it’s also the annual time to ensure you have the health insurance coverage you need for 2026.
Open enrollment on the federal Marketplace at healthcare.gov runs Nov. 1 through Dec. 15 for first-of-the-year coverage. Jan. 15 is the final date to make changes or to set up coverage that begins Feb. 1.
Employers have their own open enrollment season for signing up for health insurance at work, but commonly this happens in the fall as well.
Health insurance is an investment that protects your savings and income from unexpected health care costs.
Everyone’s situation and health care needs are unique, but the more you know about the choices and how your plan works, the better.
If your employer or your spouse’s employer offers affordable health insurance, this is your top option to consider. You may also fall into other special categories, including Medicaid for individuals or families with lower income and/or Medicare and related products, including Medicare Supplement Insurance, for those age 65 and older.
Affordable Care Act-compliant plans must cover a list of 10 essential categories of health services, including 100% coverage for preventive care like yearly check-ups, annual mammograms, immunizations or more.
Yet health insurance plans may include additional benefits, for example, a designated number of covered visits per year beyond your annual checkup. Value-added services may include discounts on fitness memberships, heart screenings and virtual visits.
High deductible health plans offer lower premiums. But if you have a health care event, you’re responsible for covering the entire deductible amount before insurance starts to cover expenses. High deductible health plans are paired with a health savings account (HSA). You can set aside pre-tax dollars in that account, but the funds can only be used for qualified health expenses. Your HSA savings can roll over from year to year.
If you know you’ll need health care services yet don’t have money saved to cover a high deductible, look for the lowest deductible plan you can afford, or consider a traditional plan.
Be aware that federal changes in premium tax credits on the Marketplace may bring about an increase in premiums. If you shop on the Marketplace for health insurance, exploring all the available plans might help. For example, if you had a Silver plan in the past, the premium for a Bronze plan might be more affordable.
As you select a plan, consider what your total out-of-pocket costs could be for health care. You’ll have the monthly premium, even if you don’t use health services. If you have a health event, you’d be responsible for out-of-pocket costs like deductible, co-pays and coinsurance.
Direct plans have a selected network of providers that may be within one health system, like Avera. They offer lower premiums, and you still have a wide range of specialists to choose from.
For most people, open enrollment is your one window of time each year to get or change health care coverage – so don’t let it slip by without taking action. If you have questions, contact your health insurance company or benefits manager at your place of work.
For questions or help with comparing Medicare D plans, contact Jackie Rau at 605-439-3331. You will need your Medicare number and current list of medications to help find a plan that works best for you and the pharmacy you choose to get your medication from.
For questions about Medicare and supplement plans, reach out to your health insurance agent and let them know where you receive your healthcare to ensure you sign up for a plan that will cover costs where you receive healthcare or be considered ‘in-network’.
You can also call Chapter to receive help finding a plan which has your healthcare provider in-network, 641-426-2691.
If you don’t have a health insurance agent, please contact SHIINE (Senior Health Information and Insurance Education) at 888-854-5321 or 605-432-8801 for assistance in finding an insurance that works for you.
While we don’t always like to think about the “what ifs” of life including a major illness or injury, it can happen to any of us, and having your health coverage in place for the upcoming year will give you protection and peace of mind.
