Before you keep your employer health plan, check next year’s paycheck deductions, provider network, prescription coverage, and out-of-pocket costs. Confirm who needs coverage and ask whether you must submit an election by your employer’s deadline.
Keeping the same health plan can make sense if it still fits your household. During open enrollment, compare this year’s documents with next year’s versions. A familiar plan name can carry a different paycheck cost, provider network, or set of drug benefits.
Compare paycheck costs and what you pay for care
Start with the rate sheet for the coverage tier you need, such as employee only or employee plus family. Multiply the new per-paycheck deduction by the number of deductions scheduled for the year. If your cost rises by $15 and you have 26 deductions, that adds $390 for the year.
Compare next year’s deductible, copays, coinsurance, and out-of-pocket limit. Add estimated costs for care you use regularly to the annual paycheck cost. If a family member expects a procedure, look at how much more you might pay in a higher-cost year. Use our guide to reading your Summary of Benefits and Coverage to find those numbers.
Check your doctors and facilities in the exact network
Look up your primary care doctor, specialists, and preferred hospital using the full plan and network name for the upcoming year. Verify the office location, especially if a practice sees patients at several sites. If you already have a visit or procedure scheduled, confirm network status with the plan and provider before your election deadline.
Look up your regular medications
Find each drug by name, strength, and form on next year’s formulary, the list of drugs the plan covers. Check its cost tier, any separate drug deductible, and whether the plan requires prior approval or limits quantities. If cost depends on where you fill it, compare your usual pharmacy with any preferred or mail-order option.
Review who needs coverage next year
Check whether a spouse or dependent needs to be added or removed and what that does to your coverage tier. If your household has access to two employers’ plans, compare the cost of covering each family member, the networks they need, and any employer rules that affect enrolling a spouse. Include expected care such as recurring therapy or specialist visits when comparing the options.
Confirm whether you need to re-enroll
Ask HR which elections carry over, which require a new election, and what happens if you take no action. Check health and dependent care flexible spending accounts separately, since their election instructions may differ from medical coverage. Save your confirmation, verify the coverage start date and dependents, and check your first paycheck after the change.
Sources & publication notes
Sources checked November 13, 2026. Figures identified as examples are original illustrations, not quotes or client results.
- CMS Summary of Benefits and Coverage
Standard coverage and cost-sharing information to compare during enrollment.
- HealthCare.gov uniform glossary
Definitions of formulary tiers, networks, prior approval, and cost sharing.
This educational guide is not a plan document or individualized tax, legal, or insurance advice; confirm requirements for your employer and coverage before acting.