Your step-by-step guide to preparing for and navigating Open Enrollment | hioscar Blog | Oscar
Your step-by-step guide to preparing for and navigating Open Enrollment
Navigate Open Enrollment with confidence. Use our 5-step guide to budget, compare plans, and choose the right coverage.
Picking a PlanOscar Member Resources
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Life changes, and a lot can happen in a year. You may have recently started freelancing. Perhaps your family grew, or your spouse's healthcare needs changed. Or maybe you've started taking medication to manage a recently diagnosed health condition. All of these scenarios can impact your healthcare needs.
Open Enrollment (opens in new tab), which runs from November 1, 2026 to December 15, 2026, is a chance to make sure your coverage still works for you. And a little preparation before enrollment begins can make choosing a plan much easier.
Whether you're shopping for Marketplace coverage for the first time or checking that your current plan still meets your needs, here's how to get ahead of Open Enrollment.
Step 1: Look back before you look ahead
Before you compare plans, think about the last year. How did you actually use your health insurance? Perhaps you connected with a primary care physician who truly understands your needs, or your spouse required specialized care. You might have started a new medication following an injury, or found that virtual consultations better suit your freelance schedule. Or, you may have just completed a particularly healthy year.
These are the details that matter when choosing a plan. Think about the doctors you'd like to keep, the medications you take regularly, and any care you know you'll need in the coming year. If there are procedures or appointments you've been putting off, now's a good time to factor those into your decision, too.
Health insurance isn't just about preparing for the unexpected. It's also about making sure the care you know you'll need is covered in a way that works for your life.
Step 2: Review your budget
For many people shopping for health coverage, cost is one of the biggest considerations. But before you compare plans, it's worth taking a few minutes to understand what your budget looks like for the coming year.
Think beyond your monthly premium: The monthly premium is important, but it's only one part of what you'll pay for healthcare over the course of the year. Think about how much room you have in your budget for doctor visits, prescriptions, or unexpected medical expenses.
Consider how often you expect to use care: If you rarely visit the doctor, your budget priorities may look different than someone managing a chronic condition or expecting surgery next year. Thinking about your expected healthcare use can help you decide whether a lower premium or lower out-of-pocket costs make more sense.
If you're self-employed, plan for income fluctuations: If your income changes from month to month, think about what feels sustainable over the course of the year — not just during your busiest season. A health plan should fit your budget even when business is slower.
Leave room for the unexpected: No one plans for a broken wrist or an emergency room visit. As you compare plans, look at your deductible and out-of-pocket maximum alongside the monthly premium. Understanding your potential costs upfront can help you avoid surprises later.
Review any changes to your household budget: Think about whether anything else has changed over the past year. Maybe you're paying for childcare now, saving for a home, helping a child through college, or covering new business expenses. Those changes can influence how much you're comfortable spending on health coverage.
Your expected household income helps determine whether you qualify for Marketplace savings (opens in new tab) that can lower your monthly premium. It doesn't have to be an exact number. A thoughtful estimate can make the enrollment process smoother and help you compare plans with a clearer picture of what you'll actually pay and whether it's affordable for you.
Step 3: Get familiar with a few key terms
Understanding a few common terms can make it much easier to compare plans and feel confident in your decision.
Here are a few you'll see often:
Premium (opens in new tab): This is the amount you pay each month to have health insurance. It’s almost like a subscription fee. A lower premium may mean you'll pay more when you receive care.
Deductible (opens in new tab): This is the amount you pay for covered healthcare services before your plan begins to pay. For example, if your deductible is $4,000, you pay for your covered services out of pocket until you reach that $4,000 total. After you meet this amount, your insurance plan begins to share the costs of your care.
Copay (opens in new tab) and Coinsurance (opens in new tab): These are the costs you may pay when you receive care, and the specific amounts depend on your plan. A copay is a fixed amount you pay for a service, like $25 for a doctor’s visit. Coinsurance is a percentage of the cost of a covered service. For example, you might pay 20% while your plan pays 80%. It helps determine what you'll pay for care throughout the year.
Out-of-pocket maximum (opens in new tab): This is the most you'll pay for covered healthcare services during your plan year. Once you reach this limit, your plan pays 100% of covered healthcare costs for the rest of the year. Understanding this number can help you prepare for the unexpected.
Provider network (opens in new tab): A provider network is the group of doctors, hospitals, specialists, and other healthcare professionals that work with your health plan. If keeping your current doctors is important to you, make sure they're in network before you enroll.
You don't need to memorize these terms. Just having a general understanding of what they mean will make comparing plans a whole lot easier.
Step 4: Decide what's most important to you
No health plan checks every box. The key is deciding which features matter most for the way you use healthcare, and which plan would give you the most confidence if your healthcare needs changed unexpectedly.
If keeping your monthly costs as low as possible is most important, you may be willing to pay more out of pocket when you need care. If you visit the doctor regularly or take ongoing medications, you may prefer a plan with a higher monthly premium but lower costs when you use your coverage.
You should also think about the care you know you'll need. If you've found an in-network primary care doctor you trust or you're seeing a specialist, check whether they're in the plan's network. If you take prescription medications, review each plan's drug coverage to make sure your medications are included.
Finally, consider how you like to access care. If your schedule is packed or you travel frequently, features like virtual care may make it easier to get care when and where you need it. As you compare options, think about which of these sounds most like you:
I want to keep my monthly payment lower: Look for plans with lower monthly premiums, but be sure to compare the deductible and out-of-pocket maximum so you know what you'll pay if you need care. Oscar Bronze plans may be a good fit if you're looking for a lower monthly premium and protection for unexpected healthcare costs. Shop and compare plans here (opens in new tab)¹.
Keeping my doctors is my top priority: If you've built relationships with your primary care doctor or specialists, check that they're in your plan's provider network before you enroll. Use Oscar's provider search tool (opens in new tab) to see which Bronze, Silver, or Gold plans include your doctors.
I rely on prescription medications: Prescription coverage can vary from plan to plan. Review each plan's drug list to make sure your medications are covered and compare what you'll pay. Compare Oscar plans to find the option that offers the prescription coverage that best fits your needs.
I'm managing an ongoing health condition: If you know you'll need regular care, look for a plan that gives you access to the specialists, medications, and support you rely on. Explore Oscar plans designed to support members managing specific chronic conditions.
I'm expecting a big healthcare year: Whether you're planning for a surgery, welcoming a baby, or know you'll need ongoing care, compare deductibles, copays, and your out-of-pocket maximum — not just the monthly premium. Oscar Gold plans may be worth exploring if you expect to use healthcare more often and want more predictable costs when you receive care. Shop and compare Oscar plans here.
I want healthcare to fit my schedule: If you're balancing work, family, or a busy calendar, think about how you'll access care throughout the year. Explore Oscar plans that include Virtual Urgent Care (opens in new tab)² and digital tools that make it easier to access care wherever you are.
I'm choosing coverage for my family: Think about your family's healthcare needs as a whole, from pediatric care and prescriptions to how often each family member typically visits the doctor. Compare Oscar plans based on your family's healthcare needs, preferred doctors, and monthly budget.
Step 5: Look beyond the monthly premium
When you're comparing health plans, it's easy to focus on the monthly premium. After all, it's the number you'll notice first.
But choosing a plan based on premium alone won't give you the full picture.
Instead, think about how all the pieces work together. A plan with a lower monthly premium may have a higher deductible or higher out-of-pocket costs when you need care. On the other hand, paying a little more each month could mean lower costs if you expect to visit the doctor regularly, fill prescriptions, or see a specialist.
This is also the time to check that your preferred doctors and hospitals are in the plan's provider network. If keeping your current care team is important to you, confirming they're covered now can save you from having to make a change later.
As you're comparing plans, ask yourself:
Which plan best fits both my monthly budget and my expected healthcare needs?
If I need care this year, am I comfortable with the deductible and other out-of-pocket costs?
Are my doctors, specialists, and prescriptions covered?
If something unexpected happened, which plan would give me the most financial protection?
Looking at these factors together can help you choose a plan that's a better fit for your health, your budget, and your peace of mind.
Before you click "Enroll"
Before making your final decision, take one last pass through the details.
Confirm that your preferred doctors are in network. Double-check that your prescriptions are covered. If you're enrolling through the Marketplace, make sure your income estimate is up to date. And don't forget to look beyond the monthly premium to understand what you'll pay if you need care during the year.
Spending a few extra minutes reviewing those details now can save you time, money, and frustration later. And remember, the best plan isn't necessarily the one with the lowest premium or the longest list of benefits. It's the one that gives you confidence that, whatever the year brings, you'll have coverage that works for you.
¹Oscar Medical coverage is underwritten by Oscar Insurance Company and its affiliates. Administrative Services for all plans provided by Oscar Management Corporation. All insurance policies and group benefit plans contain exclusions and limitations. This advertisement may be broadcast in states where policies and plans are not sold. For availability, costs, and complete details of coverage, contact Oscar at 855-672-2788.
²Oscar’s Virtual Urgent Care offerings are not available in US territories or internationally. If you have an HSA-compatible high-deductible health plan or a Secure plan, you won't be eligible for $0 visits until deductible is met. Prescriptions, visits and services may be limited per provider discretion.
