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Should you review your health insurance plan every year, even when nothing in your life has changed? Yes, and here is the reason most people miss: your plan changes even when you don’t. Insurers adjust premiums, revise drug formularies, and reshape provider networks every single year. If you auto-renew without looking, you are agreeing to next year’s version of a plan you chose based on last year’s terms.
A 30-minute review during Open Enrollment is one of the highest-return uses of your time all year. Here is what to look at.
What Changes in Your Health Plan From One Year to the Next?
Almost everything that determines your actual cost can change at renewal: your monthly premium, your deductible, your out-of-pocket maximum, your copays, which drugs are covered and at what tier, and which doctors and hospitals are in network.
Insurers are required to notify you of these changes, but the notice usually arrives as a dense packet in the fall that most people set aside. The plan you renewed into may have raised its deductible by $1,000 or moved your maintenance medication from a $10 tier to a $65 tier. Neither change requires your agreement. It happens automatically unless you act.
Network changes are the ones that hurt most. If your primary care doctor or a specialist you rely on leaves the network, you either pay out-of-network rates or start over with a new provider. That is a meaningful disruption when you have an ongoing relationship built over years.
Jonathan Potter has reviewed plans with clients every Open Enrollment since 2006, and the pattern repeats: people are surprised by what changed, not because the insurer hid it, but because nobody reads a 40-page benefits packet unprompted.
What Should You Check During Your Annual Health Insurance Review?
Work through five things in order, and you will catch nearly every issue worth catching.
- Confirm your doctors are still in network for next year. Call each office directly rather than trusting the online directory, which is often out of date.
- Run every prescription you take through next year’s formulary and note the tier and copay for each one, since a single drug moving tiers can cost you hundreds annually.
- Compare the new deductible and out-of-pocket maximum against this year’s numbers, because a lower premium often comes paired with a higher deductible.
- Think about what changed in your life this year, including a new diagnosis, a planned surgery, a new medication, a move, or a change in household income.
- Check whether your income shift affects your subsidy eligibility, since a raise or a slower year can move you into a different premium tax credit bracket.
That last item matters more than most people realize. Your subsidy is based on projected income, and if your income changed significantly, your net premium for next year could be very different from what you are paying now.
How Much Money Can an Annual Review Actually Save You?
The savings depend entirely on your situation, but the swings can be substantial. Consider a straightforward case: someone taking a brand-name maintenance drug that moves from Tier 2 to Tier 4 at renewal. If the copay goes from $45 to $120 per month, that is $900 in additional cost over the year, from one change buried in a formulary update.
On the other side, a plan with a $60 higher monthly premium but a $2,500 lower out-of-pocket maximum can be dramatically cheaper for someone with a chronic condition or a planned procedure. The premium is the number people compare, but it is rarely the number that determines total annual cost.
Working through the comparison with someone who does it professionally usually takes less than an hour. If you want a second set of eyes on your options, reviewing your individual health insurance plan options with a licensed broker costs you nothing, because the broker is paid by the carrier rather than by you.
What Happens If You Skip the Review and Just Auto-Renew?
If you take no action by the December 15 deadline, healthcare.gov will typically re-enroll you automatically in your current plan or, if that plan is discontinued, match you to a similar one from the same insurer. Your coverage continues without a gap, which is the upside.
The downside is that you have accepted every change the insurer made without evaluating whether a better option exists. You are also locked in for the full calendar year unless you experience a qualifying life event. There is no mid-year do-over for choosing the wrong plan.
For Medicare beneficiaries, the same logic applies with different dates. The Medicare Annual Enrollment Period runs October 15 through December 7, and plans issue an Annual Notice of Change each September detailing what is different for the coming year.
When Is the Right Time to Review Your Plan?
Start in early November, as soon as next year’s plan details are published and Open Enrollment opens. For ACA Marketplace coverage, Open Enrollment runs November 1 through January 15, but enrolling by December 15 is what gets your coverage started January 1.
Waiting until January means your new plan does not take effect until February, leaving a month where you are still on the old plan under new terms. Starting in early November gives you six weeks to compare carefully rather than rushing a decision in the final days.
If a major life change happens mid-year, such as a marriage, a birth, a job loss, or a move, you do not have to wait for November. Those events open a 60-day Special Enrollment Period. Reach out to Beacon Insurance Advisors whenever something changes, and you can find out quickly whether you have options available right now.
FREQUENTLY ASKED QUESTIONS
Do I have to change plans if I review my coverage?
No. Reviewing your plan does not obligate you to switch. Many people go through the comparison and conclude their current plan is still the best fit, which is a useful outcome in itself. The point of the review is to make an informed choice rather than a default one.
How will I know if my plan changed for next year?
Your insurer is required to send you a notice before Open Enrollment describing changes to your premium, benefits, and cost-sharing. For Marketplace plans this typically arrives in October, and for Medicare plans it is the Annual Notice of Change sent in September. Read it rather than filing it away, since it is the clearest summary of what will be different.
Can a broker review my plan even if I did not enroll through one?
Yes. A licensed broker can review your current coverage regardless of how you originally enrolled and compare it against other plans available in your area. There is no cost for the review, and there is no obligation to switch or to enroll through the broker afterward.
Your health plan changes every year whether you review it or not, and auto-renewing means accepting those changes without evaluating them. Thirty minutes in November can save you from a year of paying more than you needed to. Connect with Beacon Insurance Advisors for a no-pressure review of what changed and what your alternatives look like.