Open Enrollment OS: Pick Plans, Max Benefits, and Keep More Paycheck

Introduction

Open Enrollment feels like alphabet soup: PPO, HDHP, HSA, FSA, coinsurance, OOP max. The fix is a single comparison sheet and a few decision rules. In 60–90 minutes you can choose a plan, set contributions, and lock optional benefits that quietly protect your wallet.

1) Gather inputs (15 minutes)

Last year’s usage: primary/urgent visits, specialist, therapy, prescriptions, procedures.
Known events next year: surgeries, maternity, ongoing therapy, high‑cost meds.
Employer contributions: HSA seed, FSA match, 401(k) match, premiums for dependents.

2) Build the plan comparison sheet

3) Calculate expected annual cost (base case)

For each plan:
Expected Cost ≈ Premiums + Min(Your Expected Spend, Deductible) + Coinsurance on spend beyond deductible + Copays − Employer HSA Seed − Tax savings from pre‑tax accounts.
Also model Worst Case = Premiums + OOP Max − HSA seed.

4) HDHP vs. PPO in plain terms

HDHP (pairs with HSA): lower premiums, higher deductible; best if you’re generally healthy or can absorb higher upfront costs; HSA offers triple tax advantages (pre‑tax in, tax‑deferred growth, tax‑free qualified spend).
PPO: higher premiums, lower point‑of‑care costs; predictable if you expect regular care or prefer lower deductibles.

Rule of thumb: if Expected Cost (HDHP) + cash buffer − HSA tax benefits beats PPO, and your providers are in‑network, HDHP often wins. If you expect high utilization early in the year or need predictable copays, PPO may be calmer.

5) HSA vs. FSA (know the differences)

HSA (with HDHP only): yours forever, investable, rollover every year. Consider at least contributing to capture any employer seed and future tax‑free growth.
Healthcare FSA: pre‑tax, use‑it‑or‑lose‑it (some plans have small carryovers or grace periods). Good for predictable costs (therapy, contacts).
Dependent Care FSA: separate pre‑tax bucket for childcare/eldercare.

6) Rx reality check

List your medications; check each plan’s formulary tier and mail‑order options. A single high‑tier Rx can swing the math—don’t skip this step.

7) Disability insurance (quiet income protector)

Short‑term disability (STD): covers weeks to months.
Long‑term disability (LTD): the big one—aim for own‑occupation if offered.
If premiums are employee‑paid with after‑tax dollars, any benefits paid out are often tax‑free (verify your plan). Small cost, big downside protection.

8) Life insurance and beneficiaries

At minimum, set beneficiaries (and contingent). Employer basic life is often cheap; buy more only if needed after reviewing personal policies. Update after life events.

9) Vision and dental

If your usage is routine, basic plans often pencil out. If you need major dental work (crowns, orthodontics) or specialty lenses, run the math on specific procedures and annual maximums.

10) Contribution strategy (simple, effective)

Fund HSA to at least get the employer seed; if budget allows, aim higher for tax advantages.
Set FSA to match realistic forecast (contacts, copays); err slightly conservative to avoid forfeits.
Revisit mid‑year if allowed after qualifying events.

11) Checklist & cadence

Verify in‑network providers.
Read the OOP Max fine print (individual vs. family, embedded deductibles).
Save PDFs of plan summaries and your chosen contributions.
Calendar a mid‑year review to adjust FSA usage and revisit Rx options.

Pitfalls

Choosing by premium alone, ignoring Rx tiers, overfunding FSA then forfeiting, skipping LTD, or assuming all networks include your doctors.

The compounding effect

One clean enrollment can save four figures and smooth surprise bills. HSAs, when invested, build a health reserve that compounds for years.

Bottom line: Put all plans on one page, run the math, and let the numbers—not acronyms—choose for you.