What you need to know about Open Enrollment for health insurance

Toward the end of every year, millions of people across the country choose their health insurance coverage for the new year ahead.

Known as Open Enrollment, this year-end task is your opportunity to look at your choices, compare costs and coverage, and pick the plan that works best for you and your family.

Open Enrollment is available for a limited time. But certain life changes can allow you to enroll in health coverage outside of the standard Open Enrollment time frame.

Whether you’re looking to buy health insurance for the first time or change your current plan, there are some key things to consider when searching for the right plan. Follow this guide to make sure your Open Enrollment goes smoothly.

What is Open Enrollment?

Open Enrollment is the time each year when you can make decisions on your health insurance for the coming year. You can:

Enroll in a health insurance plan.
Renew your coverage.
Change your plan.
Add or remove dependents.
Cancel your plan.

Outside of Open Enrollment, the only time you can make these decisions is if you have a qualifying life event.

Many people receive health benefits through their employer. If you don’t, or the benefits they offer don’t meet your needs, you can shop for insurance through the UPMC Health Plan Marketplace.

The Marketplace allows you to compare and shop online for plans we offer, wherever and whenever it’s convenient for you.

When is Open Enrollment for health insurance?

Open Enrollment for individuals and families runs from Nov. 1, 2026, through Jan. 15, 2027.

So, if you want your coverage to start on:

Jan. 1, 2027	You must purchase a plan between Nov. 1 and Dec. 15, 2026.
Feb. 1, 2027	You must purchase a plan between Dec. 16, 2026, and Jan. 15, 2027.

This is the timeline for the general Marketplace. Employer-sponsored plan timelines may vary. There is also a separate timeline for Medicare enrollment.

It’s important to review your plan’s specific timelines so you know when to enroll. If you miss your deadline, you may not be able to enroll or change plans until the following Open Enrollment.

How to prepare for Open Enrollment

Your health, and your family’s health, is important. You want to make sure you choose an insurance plan that will work for you.

Here are some factors you should be thinking about before picking your plan.

Review your health care needs

Before you can fully evaluate whether an insurance plan fits your needs, you should know what those needs are. Take some time to think about your and your dependents’ health. For example:

How much do you expect to use your health coverage?
Do you or anyone on your plan have any chronic health conditions that need to be managed?
Will you or anyone on your plan need any procedures in the coming year?
Are you expecting any major life events in the next year? (For example: a marriage, pregnancy, childbirth, surgery, retirement, or something else.)

These factors can all help you make your health insurance choice.

Review your current plan

Take stock of the health insurance plan you have now. Think about the past year, including what worked well and what didn’t. Were you satisfied with your premiums but unsatisfied with your deductible? Do you wish you had different copays or coinsurance?

You should also review any changes in benefits or costs in your current plan. Is everything the same (or at least similar enough)? Or are there major differences?

If you’re satisfied with your current plan, you can choose to re-enroll. If you’re not, maybe a different plan would fit you better.

You may be able to speak with a representative from your insurance provider to review your current coverage.

At UPMC Health Plan, our award-winning Health Care Concierge team can help answer our members’ questions.

Call 1-844-220-4785 (TTY: 711) Monday through Friday 8 a.m. to 6 p.m. to reach a team member.

You can also chat with a Health Care Concierge by logging in to the UPMC Health Plan member site or app.

Estimate your health care expenses

Health coverage has different costs associated with it. Based on your own health care needs, you may be able to estimate your expenses based on the following:

Coinsurance—Coinsurance is your share of the cost, expressed as a percentage, after you’ve met your deductible. For example, a plan might pay 80% of the fee for services after you’ve met your deductible. Your coinsurance responsibility would be 20%.
Copays—These are fixed dollar amounts you pay each time you get a specific service. For example: $20 for a doctor’s visit or $10 for a prescription.
Deductibles—This is the amount you must pay out of pocket each year before your insurance starts covering most services. For example: If your deductible is $1,000, you pay the first $1,000 of your medical bills yourself. Then your plan starts to pay, subject to coinsurance.
Out-of-pocket maximums—This is a predetermined amount of money that you must spend before your plan covers 100% of your in-network services. Different plans can have different out-of-pocket maximums, but the federal government sets the absolute maximum limit.
Premiums—A premium is the amount you pay every month to keep your insurance active. Think of your premium as a subscription fee.

If you’re uncertain about what any of these terms mean, we’re happy to discuss them with you. Call to speak with one of our helpful team members at 1-877-563-0292 (TTY: 711).

What to consider while shopping for a health insurance plan

Your health is your most valuable asset.

It’s the foundation that makes everything else in life possible—your work, your relationships, your independence, and your ability to enjoy the world.

So, it’s important to choose a health insurer that offers many benefits for helping you manage your health and wellness.

That’s the value of choosing UPMC Health Plan.

No matter your age, health status, or occupation, UPMC Health Plan has a plan that works for you. And every plan we offer includes access to top-ranked care, award-winning customer service, helpful health care coordination, and more!

Whether it’s your first time enrolling in health insurance or you’ve done it before, you need to consider your choices carefully.

Open Enrollment tips

Choosing an insurance plan can be confusing. Here are some tips to keep in mind as you weigh your options during Open Enrollment.

How often will I use my health insurance?

Reviewing your health care needs is a great place to start. Here are some important factors to consider:

Do you go to frequent doctor’s appointments? If so, you might want a plan with low deductibles and copays.
Do you have kids? If so, you might want a plan that has low deductibles, low copays, and a low coinsurance rate.
Do you only go to the doctor’s office occasionally? Then you may want a plan with a higher deductible and low monthly premium.

What network do I need?

Your network is important because it includes the doctors, hospitals, labs, pharmacies, and other providers that your health insurance company works with at lower, negotiated prices.

Simply put, your network is the list of providers your insurance plan will cover at the lowest cost to you.

Your network matters because:

In‑network providers cost you much less because they have contracts with your insurer. Your copays, deductibles, and coinsurance are all lower when you stay in-network.
Out‑of‑network providers cost more because they’re covered at a lower rate. Sometimes, their costs are not covered at all.

To see if the UPMC Health Plan network is right for you:

If you already have a primary care provider (PCP) or specialist:	Make sure they’re in the UPMC Health Plan network. Check by using our provider directory.
If you don’t have a PCP:	Use our provider directory to view the providers in your area, many of whom allow online scheduling.
If your plan will cover children:	Know thatall our plans give you in-network access to UPMC Children’s Hospital of Pittsburgh, one of the country’s top pediatric hospitals.

Am I eligible for a subsidy?

We can help you find out!

Our account managers can walk you through the Pennie® website and help you figure out if you’re eligible for financial savings.

What is my Open Enrollment deadline?

Enroll by Dec. 15, 2026, for coverage starting Jan. 1, 2027.
Enroll by Jan. 15, 2027, for coverage starting Feb. 1, 2027.

How can I get help choosing my plan?

Our customer service team is here to answer your questions about plans. You can get help over the phone or through our easy-to-navigate Marketplace page to find a plan that is right for you.

They’ll be able to answer your questions about:

Comparisons and decision support	What’s the difference between this plan and the other one I’m considering? How do I know if a high‑deductible plan is right for me? Can you explain how an HSA or FSA works with this plan?
Coverage and benefits	What services are covered under each plan? How do they cover hospital stays, surgeries, and emergency care? What about mental health, maternity, or fertility services? Are preventive care visits fully covered?
Costs and budget	What is the monthly premium? What is the deductible, and how much will I pay for doctor visits, labs, or prescriptions? Are there copays or coinsurance for specialists? What is the out‑of‑pocket maximum? How do costs differ between in‑network and out‑of‑network care?
Family and life changes	Can my spouse and children be added? How does coverage work for newborns? What happens if I change jobs or move?
Plan rules and requirements	Do I need referrals to see specialists? Are there limits on the number of visits for certain services? What requires prior authorization? How do I file a claim if needed?
Prescriptions	Are my medications covered? What are the copays for generic vs. brand‑name drugs? Is there a formulary I can review?
Providers and networks	Is my current doctor in-network? Which hospitals are included? What happens if I need care while traveling? How large is the network in my area?
Support and tools	Is there a mobile app to track claims and benefits? How do I find in‑network providers? Who do I call for help with billing issues? Is there a number I can call to speak to a customer service representative?

What happens if I miss Open Enrollment?

If you miss the Open Enrollment window, you typically cannot sign up for a health plan for another year. One exception would be if you qualify for a special enrollment period, such as when you have a qualifying life event.

Make a note of your enrollment deadlines so you don’t miss your window!

What is considered a qualifying life event?

Big changes in your life may allow you to have a special enrollment period. A special enrollment period means you can buy coverage outside the Open Enrollment period.

The following changes are considered qualifying life events:

Getting married
Having a baby
Losing your existing health coverage (possibly due to a change in employment)
Moving to a location where your health plan is not accepted
Turning 26 years old and aging out of coverage from a parent’s or guardian’s plan
Experiencing anything on this longer list of qualifying life events

If you have one of these situations, you may qualify for a special enrollment period. You have 60 days from the date of your qualifying life event to find a new plan and enroll.

Note that in some cases, dependents can remain on their parent’s or guardian’s plan through the remainder of the calendar year in which they turn 26. Those who are about to turn 26 should check with their current insurer to learn how long they will remain covered by that policy after their 26th birthday.

How to enroll during Open Enrollment

Ready to enroll? Here are the final steps you need to take:

Review your available plan options—Take a look at all of your options, whether they’re through your employer or the Marketplace.
Compare benefits and costs—Look at the similarities and differences between your options. See how they compare in terms of coverage and cost. This can help you make your final decision.
Confirm your provider’s participation—Make sure your preferred health providers are in-network.
Gather all required information—Make sure you have everything you need, including number of dependents; the names, Social Security numbers, and mailing addresses of everyone on the plan; household income; and more.
Complete your enrollment before the deadline—This is crucial. Remember: If you want your coverage to start Jan. 1, 2027, you must enroll between Nov. 1 and Dec. 15, 2026. If you want your coverage to begin Feb. 1, 2027, you must enroll between Dec. 16, 2026, and Jan. 15, 2027.
Keep a copy of your enrollment confirmation—It’s best to have this for your records, or in case any questions come up about your enrollment.

How can UPMC Health Plan help me with Open Enrollment?

If you have questions or need help choosing a plan that provides full in-network access to UPMC’s great doctors and hospitals, we have two options to help you:

Call the UPMC Health Plan Open Enrollment helpline at 1-877-563-0292 (TTY: 711).

Shop using the UPMC Health Plan Marketplace starting on Nov. 1, 2026.

Sources

Health Insurance Marketplace, Get Ready to Apply for or Re-Enroll in Your Health Insurance Marketplace® Coverage. Accessed September 2026. https://www.healthcare.gov/downloads/apply-for-or-renew-coverage.pdf Link

HealthInsurance.org, Glossary: Health insurance and Obamacare terms. Accessed September 2026. https://www.healthinsurance.org/glossary/ Link