Fall is enrollment season: The Health Insurance Marketplace® open enrollment takes place now for coverage beginning in 2026.

Types of networks matter: HMOs, EPOs, PPOs, and POS plans each come with different costs and levels of flexibility.

Don’t skip coverage: Medical bills remain a leading cause of bankruptcy. Insurance helps protect both your health and your finances, creating a more secure future.

Why Health Insurance Matters

Health insurance is more than just another monthly bill—it’s a safeguard for both your health and your finances. Without it, the costs of an unexpected accident or illness can be devastating. According to a recent Transamerica Institute survey, 41% of workers say they are seeking medical attention when needed, and even fewer (35%) are getting routine physicals and recommended health screenings.¹ Skipping care now may mean higher costs—and more serious health concerns—later.

So, whether you’re considering changing your health insurance plan, know someone who might want to change their health insurance plan, or simply want to learn more, this article is for you. 

Understanding the Basics

At its core, health insurance is a contract: you pay a monthly premium, and in return, your insurer helps cover medical expenses. Most plans also include provider networks—groups of doctors, hospitals, and specialists that contract with the insurance company. These networks determine where you can receive care, how much flexibility you have in choosing providers, and how much you’ll pay out of pocket.

Four Main Types of Provider Networks

• HMO (Health Maintenance Organization) have lower costs but limited to in-network providers. Referrals are usually required.
• EPO (Exclusive Provider Organization) consist of coverage only for in-network providers (except emergencies).
• POS (Point-of-Service) plans have lower costs in-network, but you need referrals for specialists.
• PPO (Preferred Provider Organization) typically give you more flexibility with out-of-network coverage but at a higher cost.

Tip: Less flexibility often means lower premiums, while more flexibility usually comes with higher premiums.

Essential Health Benefits

When reviewing plans, make sure they cover the 10 Essential Health Benefits required by the Affordable Care Act. These include preventive care, hospitalization, emergency services, maternity care, mental health services, and more. Full details are available in our essential health benefits guide.

Tip: 2026 Essential Health Benefits will look different than previous years. 

Employer Open Enrollment

If you get coverage through your employer, fall is typically when benefit elections take place. Don’t assume this year’s options are the same as last year’s. Review:

• Premiums
• Deductibles
• Coverage details
• Network providers

Marketplace Open Enrollment 2025

For those without employer coverage—such as self-employed, unemployed, or underinsured individuals—the Marketplace Open Enrollment runs November 1, 2025, to January 15, 2026 (dates may vary by state).²

Who’s eligible? Adults aged 19–64 without Medicare, Medicaid, or employer-sponsored coverage. If you’re already enrolled, this is your chance to update or switch plans. 

Visit HealthCare.gov to apply.

Choosing a Plan: Bronze, Silver, Gold, Platinum

Plans are grouped into four tiers³:

• Bronze plans have the lowest premiums, highest deductibles. Best for young, healthy individuals.
• Silver plans have moderate premiums and cost-sharing. Some may qualify for extra savings.
• Gold & Platinum plans have the highest premiums and lowest deductibles. Best for those expecting higher medical needs.

Tip: Always check the provider directory to confirm your doctors and specialists are covered.

Balancing Premiums and Deductibles

Think about how often you use health services. A higher premium/low deductible plan may make sense if you:

• See doctors regularly.
• Take costly medications.
• Expect a baby or surgery.
• Manage a chronic condition.

Meanwhile, lower premium/high deductible plans may be a better fit for those who rarely need care. Some also qualify for:

• HSAs (Health Savings Accounts): Pre-tax savings accounts for medical expenses.
• HRAs (Health Reimbursement Arrangements): Employer-funded reimbursements for eligible costs.

What If You Miss the Deadline?

If you miss the January 15 deadline, you may still qualify for a Special Enrollment Period if you experience a major life event, such as:

• Marriage
• Birth of a child
• Loss of coverage
• Moving homes

Otherwise, you’ll need to wait until the next Open Enrollment.

Final Thoughts

Fall isn’t just pumpkin spice season—it’s decision season for your health coverage. Making an informed choice now can help protect your health, finances, and peace of mind next year. 

1. Transamerica Center for Retirement Studies. (2025, June). An Uncertain Future: Retirement Prospects of 4 Generations. (25th Annual Transamerica Retirement Survey of Workers). https://www.transamericainstitute.org/docs/research/generations-age/uncertain-future-retirement-prospects-four-generations-survey-report-june-2025.pdf?sfvrsn=1d68df40_7
2. Healthcare.gov (2025). A quick guide to the Health Insurance Marketplace. https://www.healthcare.gov/quick-guide/dates-and-deadlines/
3. Healthcare.gov (2025) Health plan Categories: Bronze, Silver, Gold & Platinum. https://www.healthcare.gov/choose-a-plan/plans-categories/