Your 2026 Open Enrollment Checklist: 7 Numbers You Need Before Choosing a Plan
Your 2026 Open Enrollment Checklist: 7 Numbers You Need Before Choosing a Plan
Open enrollment is live. Your HR department just sent the same four-column PDF they send every year — plan name, premium, deductible, copay. You have two weeks to decide.
Most people spend less than 15 minutes on this decision. They glance at the premiums, pick something that looks familiar, and move on. According to a National Bureau of Economic Research study, this approach costs the average employee $1,500 per year in excess healthcare spending. Not because people are careless — because the decision is genuinely complex, and the information presented doesn't make it solvable.
Here are the 7 numbers you need to collect before you can make an informed choice. Gathering them takes about 30 minutes. That 30 minutes could save you more per hour than any side hustle on the internet.
Number 1: Your Total Annual Prescription Drug Cost (Current Plan)
Log into your insurance portal or pharmacy app and pull the total you paid out-of-pocket for prescriptions in the past 12 months. Not the retail price — the actual amount that hit your wallet after insurance.
This number matters because drug formulary placement varies wildly across plans. Your $15/month generic on Plan A might be $45/month on Plan B because it's classified a tier higher. Over 12 months, that's a $360 difference — on a single medication.
If you take multiple prescriptions, this gap compounds fast. We broke down exactly how formulary tiers create hidden cost differences in our prescription drug coverage guide — the short version is that the plan with the lowest premium often has the most expensive drug coverage.
Your number: $_______ /year in prescription costs
Number 2: Your Expected Doctor Visits (By Type)
Count your visits from the past year, broken into three categories:
- Primary care visits: annual physical, sick visits, routine checkups
- Specialist visits: dermatologist, cardiologist, orthopedist, etc.
- Urgent care / ER visits: unplanned visits
Primary care visits are usually covered with a flat copay ($25-$50) regardless of plan type. Specialist visits are where plans diverge — some charge a $50 copay, others charge 20-40% coinsurance after the deductible. One specialist visit billed at $400 could cost you $50 on one plan and $160 on another.
Texas families shopping for family plans need to pay special attention here — family deductibles are typically 2x the individual deductible, meaning the gap between plans widens as household size increases.
Your numbers: ___ PCP visits, ___ specialist visits, ___ urgent/ER visits
Number 3: Your Marginal Tax Rate
Pull up your most recent tax return. Find your taxable income and look up your marginal federal tax rate (2026 brackets: 10%, 12%, 22%, 24%, 32%, 35%, 37%). Add your state income tax rate if applicable.
This number determines whether an HSA-eligible HDHP plan makes financial sense. An HSA contribution of $4,150 (2026 individual limit) at a 32% combined federal+state rate saves you $1,328 in taxes. At a 12% rate, the same contribution saves $498. The tax benefit is the single biggest variable in the HDHP vs. PPO decision — and most plan comparison tools ignore it entirely.
Your number: ___% marginal tax rate (federal + state)
Number 4: Your Household's Deductible Usage Last Year
Check your Explanation of Benefits (EOB) statements or insurance portal. How much of your deductible did you actually use last year?
If you used less than 20% of your current deductible, you're paying for coverage cushion you didn't need. If you blew past your deductible by March, you might benefit from a lower-deductible plan even at a higher premium.
This number is the single best predictor of whether your current plan is right-sized for your actual utilization. Most people either dramatically overshoot (paying high premiums for low deductibles they never reach) or undershoot (choosing high deductibles to save on premiums, then getting surprised by a single procedure).
Your number: $_______ of $_______ deductible used (____%)
Number 5: Your In-Network Provider List
Write down every doctor, specialist, therapist, and facility you visited in the past year. For each provider, check whether they're in-network on every plan you're considering.
This sounds tedious. It is. It's also non-negotiable. A single out-of-network specialist visit can cost $500-$2,000 more than the in-network rate. If you see a specialist monthly, an out-of-network classification turns a "cheaper" plan into the most expensive option on the table.
Provider network directories are notoriously inaccurate — up to 50% of listed providers may not actually be accepting new patients under that plan, according to CMS audits. Call the provider's office directly and ask: "Do you accept [Plan Name] [Plan ID]?" Trust the office, not the directory.
Your list: ___ providers confirmed in-network across ___ plans
Number 6: Any Known Procedures or Life Events
Are you planning any elective procedures this year? Is anyone in your household pregnant or planning to be? Do you have a surgery scheduled? Is a family member starting a new medication?
Known high-cost events completely change the math. A planned knee surgery billed at $25,000 means you will almost certainly hit your out-of-pocket maximum — which makes the OOP max the only number that matters, not the deductible or coinsurance rate. The plan with the lowest OOP max wins, even if its premium is higher.
Homeowners also face compound financial decisions — if you're budgeting for both healthcare and property costs, tools like WildFireCost can help you quantify property risk exposure so you're not blindsided by overlapping insurance gaps.
Your events: _________________ (estimated cost: $_______ )
Number 7: Your Risk Tolerance Number
This is the one number that no spreadsheet will give you. Ask yourself: "What is the maximum unexpected medical bill I could absorb without financial stress?"
If your answer is "I could handle a $3,000 surprise bill but $8,000 would require borrowing," then your risk tolerance caps your deductible at $3,000. Any plan with a higher deductible is betting that you won't get sick — and if you lose that bet, you're financing the difference.
If your answer is "$10,000 is fine, I have savings," then a high-deductible plan with HSA tax benefits might genuinely be optimal. The math on when HDHPs save money is more nuanced than most people realize — as we explored in how Pelandri's optimizer calculates across 10,000 scenarios, risk tolerance changes which plan "wins" even when the expected cost numbers are identical.
Your number: $_______ maximum comfortable surprise bill
Putting the 7 Numbers Together
With these seven numbers in hand, you're equipped to make an informed decision rather than an anxious guess. Here's the framework:
| Scenario | Likely Best Fit |
|---|---|
| Low utilization + high tax rate + high risk tolerance | HDHP with HSA |
| High utilization + known procedures | Lowest OOP max plan |
| Multiple specialists + specific medications | Plan with best network + formulary match |
| Young, healthy, no prescriptions | Cheapest premium (usually HDHP) |
| Chronic condition + regular prescriptions | Plan with lowest cost-sharing for your specific drugs |
The table above is a starting point — it gets you directionally correct, but it can't account for the interactions between all seven variables simultaneously. That's what Pelandri's optimizer does: you enter your medications, providers, expected utilization, tax rate, and risk tolerance, and it simulates 10,000 cost scenarios across every available plan to find the one that actually minimizes your total annual cost.
The 30-Minute Rule
Thirty minutes of preparation. Seven numbers. A decision worth $1,500/year.
You wouldn't buy a car without checking the price, the insurance rate, the fuel cost, and the maintenance history. Your health insurance costs more than most cars. Give it at least the same 30 minutes.
Run your 7 numbers through Pelandri's optimizer and see which plan wins →
Sources
- Choosing Health Plans: The Role of Inertia and Inattention — National Bureau of Economic Research
- 2025 Employer Health Benefits Survey — Kaiser Family Foundation
- IRS Revenue Procedure 2025-19: HSA Contribution Limits — Internal Revenue Service
- Provider Directory Accuracy Study — Centers for Medicare & Medicaid Services