Open enrollment: How to choose health insurance that works for your family

ST. LOUIS — A health insurance plan can look affordable until someone needs surgery, a child needs regular treatment or a prescription comes with an unexpected bill.

Open enrollment gives households time to review those costs before choosing coverage for the coming year. The decision should account for the care each family member needs, access to doctors and hospitals, and what the household could afford during a serious illness.

Watch: Choosing health insurance for your family

This narrated animated guide explains the costs and shows how different households can compare coverage.

For Missouri residents using HealthCare.gov, enrollment for 2027 runs from November 1, 2026, through January 15, 2027. Enroll by December 15 for coverage beginning January 1, and pay the first premium by the insurer’s deadline. Later enrollment generally means coverage starts February 1. Employer plans have their own enrollment deadlines. ^[1][2]

What makes a plan a good fit?

Useful coverage connects a family with needed care at manageable costs. Marketplace plans cover broad categories including doctor visits, hospitalization, prescriptions, maternity care and mental health treatment. Specific benefits and restrictions vary. ^[3]

Check whether your doctors, pediatricians and preferred hospitals participate in the exact plan you are considering. Confirm with both the insurer and the provider. Review the formulary, the plan’s covered-drug list, for each regular prescription and its cost. Networks and benefits can change even when the insurance company’s name stays the same. ^[4]

Understand the costs

• Premium: The payment that keeps coverage active, even when you do not use it. A $300 monthly premium costs $3,600 over a full year. Use the amount your household would actually pay after any employer contribution or financial assistance. ^[5]
• Copay: A fixed charge for a covered service, such as $30 for a primary care visit. Specialist visits and prescriptions may have different copays. Some services have copays before the deductible is met; others require meeting it first. Check the plan’s rules. ^[6][7]
• Deductible: The amount you pay for services subject to the deductible before the plan begins sharing those costs. With a $2,000 deductible, you generally pay the first $2,000 of those covered expenses. Some services are covered earlier. Certain preventive services are generally free in network, even before meeting the deductible. ^[8][9]
• Coinsurance: Your percentage of a covered service’s allowed cost, usually after the deductible. With 20% coinsurance on a $1,000 allowed charge after meeting the deductible, you pay $200 and the plan pays $800. The allowed amount is the insurer’s negotiated or recognized price. ^[10]
• Out-of-pocket maximum: The annual limit on your share of covered, in-network care. Deductibles, copays and coinsurance count toward it. After reaching it, the plan pays 100% of covered, in-network benefits for the rest of the plan year. Premiums, noncovered services and generally out-of-network expenses fall outside that protection. ^[11]

Meeting a deductible usually does not end your bills. For example, assume a covered hospital stay has a $10,000 allowed cost, your entire $2,000 deductible remains, and you owe 20% coinsurance afterward. Your share would be $3,600: the $2,000 deductible plus $1,600 on the remaining $8,000, assuming your out-of-pocket maximum does not reduce that amount. ^[10]

Compare the full year

Estimate annual premiums plus what you expect to pay for care. Also compare annual premiums plus the out-of-pocket maximum to understand your exposure in a year with substantial covered, in-network expenses. The deductible is already included in that maximum; do not add it again. ^[5][11]

These invented figures illustrate two plans for one adult. They are not insurance quotes.

Cost	Plan A	Plan B
Monthly premium paid by the enrollee	$250	$375
Annual premiums	$3,000	$4,500
Deductible	$4,000	$1,500
Out-of-pocket maximum	$8,500	$6,000
Annual premiums plus out-of-pocket maximum	$11,500	$10,500

Plan A costs $1,500 less in annual premiums. If enough covered care pushes both plans to their out-of-pocket maximums, Plan B costs $1,000 less overall. Actual results depend on the care received and each plan’s benefits.

How different households can compare

The following households are hypothetical examples.

Household	Example and what to compare
One adult	Someone who uses little care might consider a lower-premium plan, while checking whether savings could cover its deductible after an accident. Someone taking expensive medication should compare prescription costs and out-of-pocket limits even if doctor visits are infrequent.
Two adults	One adult may need only occasional visits while the other sees a specialist regularly. Include both people’s appointments, tests and medications. If both have employer options, compare separate employee plans with joint coverage, including employer contributions and each arrangement’s deductibles and limits.
Two adults and one child	If a child has asthma, compare pediatricians, specialists, urgent care and the exact inhaler. In a hypothetical comparison, an inhaler costing $10 monthly under one plan and $75 under another creates a $780 annual difference before premiums or other care.
Two adults and four or five children	Consider the combined cost of sick visits, prescriptions and recurring treatment, alongside individual and family limits. For illustration, 20 visits at a $30 copay cost $600; at $60, they cost $1,200, assuming those copays apply and no maximum has been reached.

These examples apply the same comparison: expected household care, annual premiums and the amount the family could owe if needs increase. ^[4][5]

Family deductibles deserve special attention. In a hypothetical plan with an embedded $2,000 individual deductible and a $4,000 family deductible, one person can receive post-deductible benefits after meeting their $2,000 threshold. Once combined deductible spending reaches $4,000, the family deductible is met. Copays or coinsurance may continue. Other plans require meeting the overall family deductible first for services subject to it. Ask how both the deductible and out-of-pocket limits work for each person and the family. ^[7]

Check benefits and available help

Read each plan’s Summary of Benefits and Coverage, which outlines covered services, costs, limitations and examples. Check specialist referral requirements and whether treatments need prior authorization, or approval from the insurer. Bronze, Silver, Gold and Platinum describe how costs are shared; they do not grade the quality of medical care. ^[7][12][13]

Eligible households may qualify for premium tax credits. Income-based cost-sharing reductions can also lower deductibles, copays and coinsurance, but require choosing a Silver Marketplace plan. Eligibility depends on household circumstances, including access to qualifying employer coverage. ^[2][14]

Children may qualify for Medicaid or the Children’s Health Insurance Program even when their parents use different coverage. Applications for Medicaid and CHIP are accepted year-round. ^[15]

Missouri residents can compare coverage at HealthCare.gov and find free enrollment assistance through Cover Missouri. Metro East residents can use Get Covered Illinois, where enrollment also ends January 15, 2027, with December 15 as the deadline for January 1 coverage. Outside open enrollment, qualifying events such as losing other coverage, getting married or having a baby may provide another enrollment opportunity. ^[1][4][16]

Cover photo: VOTP News STL.

Sources

1. HealthCare.gov: Enrollment dates and deadlines
2. HealthCare.gov: Comparing job-based and Marketplace coverage
3. HealthCare.gov: What Marketplace plans cover
4. Missouri Department of Commerce and Insurance: 2027 rates and consumer guidance
5. HealthCare.gov: Total yearly costs
6. HealthCare.gov: Copayment
7. CMS: Summary of Benefits and Coverage instructions
8. HealthCare.gov: Deductible
9. HealthCare.gov: Preventive services
10. HealthCare.gov: Coinsurance
11. HealthCare.gov: Out-of-pocket maximum
12. CMS: Summary of Benefits and Coverage
13. HealthCare.gov: Choosing a plan and metal categories
14. HealthCare.gov: Cost-sharing reductions
15. HealthCare.gov: Children’s Health Insurance Program
16. Get Covered Illinois: Open enrollment