Dec. 1, 2025

This piece is sponsored by Avera Health.

Fall brings football season, bonfires and, of course, pumpkin spice. It’s also the annual time to ensure that you have the health insurance coverage you need for 2026.

Open enrollment on the federal Marketplace at healthcare.gov runs through Dec. 15 for first-of-the-year coverage. Jan. 15 is the final date to make changes or to set up coverage that begins Feb. 1.

“If you get your health insurance from the federal Marketplace or if you don’t have health insurance and you need to get it, be sure not to miss open enrollment. Unless you have a life-qualifying event, like getting married or a job change, you won’t be able to buy health insurance at any other time during the year,” said Kate Serenbetz, individual product manager for Avera Health Plans.

The Marketplace is the key source of health insurance for people who are solopreneurs, self-employed, ag producers or people who don’t have access to affordable coverage through their employer.

Employers have their own open enrollment season for signing up for health insurance at work, but commonly this happens in the fall as well.

Health insurance is an investment that protects your savings and income from unexpected health care costs.

Know your health insurance options 

Everyone’s situation and health care needs are unique, but the more you know about the choices and how your plan works, the better.

If your employer or your spouse’s employer offers affordable health insurance, this is your top option to consider. You also may fall into other special categories, including Medicaid for individuals or families with lower income and Medicare and related products, including Medicare Supplement Insurance, for those 65 and older.

Affordable Care Act-compliant plans must cover a list of 10 essential categories of health services, including 100 percent coverage for preventive care like yearly checkups, annual mammograms, immunizations and more.

Yet health insurance plans may include additional benefits, for example, a designated number of covered visits per year beyond your annual checkup. Value-added services may include discounts on fitness memberships, heart screenings and virtual visits.

High-deductible health plans offer lower premiums. But if you have a health care event, you’re responsible for covering the entire deductible amount before insurance starts to cover expenses. High-deductible health plans are paired with a health savings account. You can set aside pre-tax dollars in that account, but the funds can be used only for qualified health expenses. Your HSA savings can roll over from year to year.

“If you know you’ll need health care services yet don’t have money saved to cover a high deductible, look for plans with lower deductibles and copays for services you commonly use,” Serenbetz said.

Be aware that federal changes in premium tax credits on the Marketplace may bring about an increase in premiums. “If you shop on the Marketplace for health insurance, exploring all the available plans might help,” Serenbetz said. “For example, if you had a silver plan in the past, the premium for a bronze plan might be more affordable.”

Consider potential costs and benefits

As you select a plan, consider what your total out-of-pocket costs could be for health care. You’ll have the monthly premium, even if you don’t use health services. If you have a health event, you’d be responsible for out-of-pocket costs such as the deductible, copay and coinsurance.

Direct plans, like DirectConnect through Avera Health Plans, have a selected network of providers that may be within one health system, like Avera. They offer lower premiums, and you still have a wide range of specialists to choose from.

For most people, open enrollment is your one window of time each year to get or change health care coverage – so don’t let it slip by without taking action. If you have questions, contact your health insurance company or benefits manager at your workplace.

“Even in light of possible premium increases, it’s not a good option to go without health insurance. If you have a major health event in your family that results in large bills, your income and savings could be at risk,” Serenbetz said.

Learn more about health insurance options through Avera Health Plans.