Open enrollment can feel overwhelming. Deductibles, co-pays, HSAs, FSAs, and provider networks — it’s a lot to keep straight. But here’s the good news: benefits don’t have to be confusing.
At Andres O’Neil & Lowe, we believe that understanding your benefits is the first step to making confident choices for yourself and your family. This guide walks you through the essentials in simple terms, so you can pick a plan that truly fits your health, lifestyle, and budget.
1. Know the Basics: Key Health Insurance Terms
Before comparing plans, it helps to get comfortable with the main terms you’ll see:
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Deductible: The amount you pay out-of-pocket each year before insurance starts covering most services.
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Co-pay: A flat fee you pay when you visit a doctor or fill a prescription (for example, $25 for a primary care visit).
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Co-insurance: After your deductible is met, this is the percentage you pay for covered services (for example, 20%).
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Out-of-Pocket Maximum: The most you’ll pay in a year for covered medical expenses — after this, insurance covers 100%.
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Premium: The amount taken from your paycheck (or billed monthly) for your coverage.
Understanding these basics is the first step toward feeling confident about your options.
2. In-Network vs. Out-of-Network Providers
One of the biggest factors in your healthcare costs is whether your provider is in-network.
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In-Network Providers: Doctors, hospitals, and specialists who have agreed to discounted rates with your insurance company. Choosing them usually saves you money.
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Out-of-Network Providers: Not contracted with your insurance. Costs are often higher, and some plans may not cover them at all (except for emergencies).
Pro tip: Check your insurance carrier’s website to confirm that your doctor, specialist, or facility is in-network for your specific plan name. It’s a simple step that can prevent surprise bills down the line.
3. Prescription Coverage Matters
Even if you’re healthy overall, prescriptions can be a significant cost and vary from plan to plan. Make sure to check:
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Is your medication covered?
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Which tier does it fall under?
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Are generics or preferred alternatives available?
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What will you pay per fill?
Taking a few minutes to review your formulary now can save you money later, especially if you take regular prescriptions.
4. How to Calculate Your True Annual Cost
Monthly premiums are easy to see — but they don’t tell the whole story. Use this simple formula:
Annual Premiums (your monthly premium x 12)
+
Expected Out-of-Pocket Costs (doctor visits, prescriptions, ongoing treatments, etc.)
=
Total Expected Annual Healthcare Cost
This helps you see which plan really fits your needs and budget.
5. Understanding HSAs and FSAs
HSAs and FSAs both help you save money by using pre-tax dollars for medical expenses, but they each work very differently.
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Available only with high-deductible plans
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Triple-tax advantage: pre-tax contributions, tax-free growth, tax-free withdrawals for eligible expenses
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Funds roll over year to year
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You own the account, even if you change jobs
Flexible Spending Account (FSA)
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Available with many types of plans
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Pre-tax contributions
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Most, if not all, funds must be used within the plan year (some plans allow a small rollover)
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Employer-owned
Even small contributions to these accounts can help offset healthcare costs throughout the year.
6. Telehealth, Virtual Care, and Wellness Programs
Many plans now include convenient resources to keep you healthy — and save you time and money, including:
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24/7 telemedicine visits
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Virtual mental health counseling
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Prescription refills
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After-hours support
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Nurse hotlines
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Wellness incentives like gym discounts, health coaching, or wellness challenges
Using telehealth for minor illnesses or routine questions can save you both time and money.
7. Additional Benefits: Life & Disability Insurance
Don’t overlook your employer-offered life and disability coverage:
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Life Insurance: Provides financial security for your loved ones in the event something unexpected happens.
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Short- or Long-Term Disability: Offers income replacement if you can’t work due to illness or injury.
These benefits are usually very affordable through your employer because they are offered at group rates — and they can make a big difference for your family’s financial security. So, it makes sense to opt in if it fits your budget.
However, keep in mind that employer plans typically end when your employment does. That’s why having your own personal policy in place is still a smart move too. It gives you consistent protection that stays with you no matter where you work.
If you’re interested in exploring personal life or disability insurance options outside of what your company offers, Andres O’Neil & Lowe can help you navigate that, so you can build a comprehensive plan that protects you both now and in the future.
8. Consider Spousal & Dependent Coverage Carefully
If you cover family members, ask yourself:
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Is it more cost-effective for my spouse to stay on their own employer’s plan?
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Which plan offers the best network for my children’s doctors?
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How do deductibles, co-pays, and out-of-pocket maximums compare?
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What are prescription costs for our family?
Some employers also have spousal surcharges if your partner has access to their own coverage — another detail worth checking.
9. Ask Questions
Open enrollment can feel complicated, so ask questions and:
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Speak with HR about plan details
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Review plan materials thoroughly
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Contact your benefits advisor for guidance
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Attend open enrollment meetings
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Use online tools from your carrier
Getting clarity now will save you stress — and money — later.
10. Common Mistakes to Avoid
A few simple missteps can cost you hundreds (or thousands) later. Avoid:
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Choosing the lowest premium without checking deductible and out-of-pocket costs
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Not confirming if your or your dependents’ doctors are in-network
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Forgetting to update dependents after life changes
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Overlooking prescription coverage
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Missing FSA deadlines
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Assuming last year’s plan is still the best choice
A careful review now goes a long way toward peace of mind all year.
11. Open Enrollment Checklist
Before submitting your selections, make sure you’ve answered:
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Are my and my dependents’ doctors and specialists in-network?
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What are my prescription costs under this plan?
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How much are my total expected costs?
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Do I prefer lower monthly premiums or more predictable costs when I receive care?
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Should I use an HSA or FSA?
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Have I considered dental, vision, and voluntary life or disability benefits
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Did I add (or remove) dependents?
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Did I ask questions about anything that’s unclear?
Take Charge of Your Benefits Today
Open enrollment only comes once a year — and this is your chance to make informed decisions that support your health and financial well-being. However, it doesn’t have to feel overwhelming.
Taking a little time to review your plan details—like your deductible, co-pays, out-of-pocket maximum, and additional benefits like employer-provided life or disability insurance can go a long way in helping you choose what best fits your needs.
And remember: if something isn’t clear, your HR or benefits administrator is there to help. Asking questions is a smart way to feel confident in your choices.
If you’re an employer looking to strengthen your benefits offerings or improve how you educate your team, Andres O’Neil & Lowe is ready to help. We partner with businesses to build well-rounded employee benefits programs that protect their people, support their goals, and create long-term stability.
Your business, your team, and your future deserve the right protection.
If you’re ready to upgrade your insurance strategy or explore ways to better support your employees, contact your nearest Andres O’Neil & Lowe office in Bryan, Archbold, Hicksville, Wauseon, or Defiance or reach out online today.
We’re here to help you protect your greatest asset: your team.
