What Insurance Questions Should I Be Asking During Open Enrollment?

Having a health insurance plan is an important partnership for maintaining your health. With open enrollment in full swing, it’s time to sign up or make changes that maximize your coverage. Jordan Anderson, Senior Director of Group Sales with Avera Health Plans, provides insight on how to successfully navigate the current open enrollment season.

What is open enrollment?

So open enrollment for the individual Marketplace is that time every year that you get the opportunity to go out and look at different plans. Open enrollment is the short window of time that starts Nov. 1 and is open until Jan. 15. If you're new to the individual Marketplace, you can enroll in a plan. If you're renewing, you can see alternative options that might be available to you and may fit your future needs.

What are some of the biggest questions you wish more people asked about insurance coverage?

Most people are looking at open enrollment. They're trying to find the right plan for them and their families, right? So we advise people to look at the benefits, understand what those benefits are, and make sure you're selecting the benefits that work best for them. Many of the plans on the individual Marketplace may look similar, but until you actually go into the details and kind of peel back that proverbial benefits and see what makes sense for you, you're probably doing yourself a disservice. You may be surprised down the road when something is being covered differently than you would have expected.

What are some important factors to know when you are looking at plans?

We kind of talk about just understanding health, but things like cost, is that important? Individuals who enroll in the Marketplace may be eligible for premium savings. In addition to premium costs, enrollees on the individual marketplace may also be receiving some form of cost share reduction. So when you look at that, you're not looking at the in-full rate for that plan, but a reduced amount off of that plan. Make sure to take that into consideration as well when you're selecting a plan.

Read more: Changes to health insurance open enrollment in 2026

How are new medications and programs like GLP-1’s being covered by health insurance?

Beyond the cost, you want to look and explore what other value-added benefits or additional add-ons might come with that health plan. So things like gym membership reimbursements or condition management programs, you're going to want to explore those as well and not just focus on cost alone. Under the Affordable Care Act, preventive services are covered as one of the 10 essential health benefits. Go get your wellness check, do your colonoscopy at those times, your mammograms, etc. Make sure that you're utilizing those benefits because they are free to you.

In addition to those benefits, look at programs like our MyWeighForward plans, which are available to people in Brown, Lincoln and Minnehaha counties and offer coverage of weight loss drugs. It is a safe and easy way to be able to provide sustainable long-term weight loss for an individual. We've seen in our population that weight loss is critical to improving the overall health of an individual, and we wanted to roll out a program that would support those individuals who are looking to take that weight loss journey. With MyWeighForward, a member will have clinical support in addition to a wellness coach. We want to make sure that we're helping and supporting with those behavioral changes while they're going through the process of taking off the weight. The weight loss is supported by medications and the use of GLP-1s. Once your coach gets you to that targeted weight, we want to make sure that you maintain that weight. So we'll continue to offer those people the health support that you need, but once again it's an exciting opportunity to be innovative in that weight loss space.

Any additional tips or pointers?

Be prepared, do your homework. Remember you're really making this decision for yourself and your family. Don't look to your neighbor, don't look to that relative, don't look to that friend, but really look at what is valuable to you as an individual and to those family members that you'll be covering.