Planning for Open Enrollment
For families navigating disability, choosing health insurance can be a little more complicated than comparing monthly premiums and deductibles.
Your family may rely on specialists, therapists, behavioral health providers, prescription medications, durable medical equipment, or other services that aren't easily replaced. Your loved one may also have Medicaid or Medicare coverage that needs to work alongside private insurance.
That makes Open Enrollment an important opportunity to look at the bigger picture.
For 2027 Marketplace coverage, Open Enrollment begins November 1, 2026. In Colorado, Open Enrollment through Connect for Health Colorado runs through January 15, 2027. Enrolling by December 15 generally allows coverage to begin January 1.
Before simply renewing the plan you already have, here are eight questions worth asking.
1. Are your most important providers still in-network?
Don't assume that because your doctor or therapist was covered this year, they'll be covered next year.
For a family affected by disability, make a list of the providers who would be difficult to replace. This might include:
Primary care physicians and pediatricians
Specialists
Psychiatrists and psychologists
ABA providers
Occupational, physical and speech therapists
Behavioral health providers
Hospitals and specialty medical centers
Home health or nursing providers
Then check each plan's provider network.
If a particular specialist or therapist is essential to your loved one's care, consider contacting both the provider and the insurance company to confirm network participation for 2027.
2. What therapy and behavioral health services are actually covered?
Seeing "therapy covered" on a benefits summary doesn't necessarily tell you enough.
Look more closely at coverage for services your family currently uses or may reasonably need during the coming year. Pay attention to copays, coinsurance, deductibles, visit limits, prior authorization requirements and whether particular types of therapy are excluded.
A plan with a lower premium could ultimately cost considerably more if your child or family member attends therapy several times each week.
3. Are your prescriptions covered, and at what cost?
Review the plan's prescription drug formulary rather than assuming medications covered this year will remain covered under the same terms next year.
For each important medication, consider:
Is it covered?
What tier is it on?
What will the copay or coinsurance be?
Is prior authorization required?
Are there quantity limits?
Does the plan require use of a particular pharmacy or mail-order service?
Is the brand-name medication covered if a generic alternative isn't appropriate?
For someone taking multiple medications, relatively small differences in prescription coverage can add up quickly over a year.
4. What about durable medical equipment and other disability-related needs?
If your loved one uses wheelchairs, communication devices, orthotics, feeding equipment, diabetes supplies or other durable medical equipment, look beyond routine office-visit coverage.
Review how the plan handles the equipment and supplies you actually use.
Ask about preferred suppliers, replacement schedules, repair coverage, prior authorization requirements and your share of the cost.
A plan that looks inexpensive on the surface may be much less attractive when significant equipment needs are factored in.
5. How does this coverage work with Medicaid or Medicare?
Some individuals with disabilities have more than one source of health coverage.
For example, someone might be covered by a parent's employer-sponsored insurance while also receiving Medicaid. An adult with a disability might eventually have both Medicare and Medicaid.
When multiple types of coverage are involved, understanding which insurance pays first and which services each program covers becomes important.
Don't assume that adding or changing private insurance will have no effect on the rest of the person's health coverage. Before making a change, understand how the different pieces are intended to work together.
6. Are you comparing total annual costs, not just premiums?
It's tempting to start with the monthly premium. For families with significant health care utilization, that's often the wrong number to focus on.
HealthCare.gov recommends considering total health care costs, including premiums and out-of-pocket expenses, when comparing plans.
Think about what a typical year actually looks like for your family.
Consider:
Annual premiums + deductible + copays + coinsurance + prescription costs + therapy costs + equipment costs + likely out-of-network expenses.
Also compare each plan's out-of-pocket maximum.
If your family regularly uses a significant amount of health care, a plan with a higher monthly premium but substantially better coverage may result in lower overall costs
7. Does an HSA or FSA make sense for your family?
If you're choosing an employer plan, Open Enrollment is also a good time to review your Health Savings Account or Flexible Spending Account elections.
Families with predictable medical, therapy, prescription, dental or other eligible health care expenses may be able to use these accounts to pay qualifying expenses with pre-tax dollars.
But don't choose a high-deductible health plan simply because it offers access to an HSA. Consider whether the plan itself makes sense given your family's expected health care needs.
The tax benefit is one piece of the decision, not the entire decision.
8. Has anything changed for 2027?
Even if you think your current plan is the best option, review it.
Premiums can change. Provider networks can change. Prescription formularies can change. Deductibles and copays can change. Your family's health needs can change too.
Colorado families have an additional reason to pay attention this year. Cigna is leaving Colorado's individual medical insurance market for 2027, so affected customers will need different coverage. Connect for Health Colorado is also advising returning customers that automatic re-enrollment does not mean premiums, financial assistance, benefits, provider networks or other coverage details will remain the same.
In other words, "we'll just keep what we have" deserves a second look.
Start With Your Family, Not the Insurance Plan
Open Enrollment isn't simply about finding the cheapest health insurance policy. For families affected by disability, it's about finding coverage that supports the care your family actually needs.
Start by making a list of the things that matter most:
Your providers. Your medications. Your therapies. Your equipment. Your expected medical care. Your other insurance or public benefits.
Then compare plans against that list.
That's planning with purpose: rather than starting with the available products and trying to make your family's needs fit them, start with the life you're supporting and identify the tools that fit around it.
A Simple Open Enrollment Checklist
Before selecting or renewing coverage, review:
☐ Doctors and specialists
☐ Therapists and behavioral health providers
☐ Hospitals and specialty centers
☐ Prescription medications
☐ Therapy coverage and visit limits
☐ Durable medical equipment and supplies
☐ Deductible and out-of-pocket maximum
☐ Copays and coinsurance
☐ Out-of-network benefits
☐ Prior authorization requirements
☐ HSA or FSA options
☐ Coordination with Medicaid or Medicare
☐ Expected total annual cost
Taking a little extra time during Open Enrollment can help prevent unpleasant surprises after January 1.
This article is intended for general educational purposes and should not be considered individualized insurance, legal, tax or financial advice. Health insurance coverage and public benefit rules vary based on individual circumstances and may change.
