Open Enrollment is a crucial period for both employers and employees. As we approach the 2026 enrollment season, we want to ensure clients and readers understand the process, requirements and best practices that can help foster better participation and ensure compliance.
The following guide combines essential information to help you navigate the upcoming Open Enrollment period with confidence.
Open Enrollment: The Basics
Open enrollment is the designated annual window when employees can enroll in, change, or cancel their health insurance and other benefits coverage. Typically occurring in the fall and lasting two to four weeks, this period allows employees to make important decisions that impact their health and financial well-being for the coming year.
Effective communication during this time is critical. Many employees miss deadlines or make uninformed choices due to confusing jargon, insufficient information, or a lack of understanding about the process. By providing clear, accessible information, employers can boost participation rates and help employees make choices that best suit their needs.
Key Changes for 2026
Several important updates will affect the 2026 open enrollment period:
- The Affordable Care Act (ACA) affordability percentage will increase to 9.96% for plan years beginning in 2026, a significant rise from the 2025 rate of 9.02%.
- Out-of-pocket maximums (OOPMs) for essential health benefits will increase to $10,600 for self-only coverage and $21,200 for family coverage.
- High Deductible Health Plan (HDHP) limits will adjust to minimum deductibles of $1,700 (self-only) and $3,400 (family).
- HSA contribution limits will increase to $4,400 for individuals and $8,750 for family coverage.
- Telehealth services can be provided before the HDHP deductible is met without jeopardizing HSA eligibility.
These changes provide opportunities for both employers and employees to adjust their strategies for health care coverage and savings.
Terms that Employees Should Know
To make informed decisions, employees need to understand several key terms that will affect their coverage and costs:
- Premium: The amount paid (usually monthly) to keep health insurance active, regardless of whether services are used. Typically deducted directly from employee paychecks.
- Deductible: A set amount that must be paid before insurance begins sharing costs for covered medical expenses. HDHPs have higher deductibles but lower premiums.
- Copayment: A fixed amount paid when receiving certain services or prescription medications, with plans having higher premiums typically offering lower copayments.
- Coinsurance: Represents a percentage of costs shared between the insured and the insurance company after meeting the deductible, with common splits including 80/20 or 70/30, where the insurance pays the larger portion.
- Out-of-Pocket Maximum: The most an individual will pay for covered health care services in a plan year. After reaching this limit, the plan typically covers 100% of in-network covered costs for the remainder of the year.
Compliance Considerations
Employers that sponsor health plans and notices should provide certain benefits notices in connection with their plans’ open
enrollment periods.
- SBC: The Summary of Benefits and Coverage (SBC) must be included with open enrollment materials.
- Medicare Part D: Notices inform Medicare-eligible individuals whether prescription drug coverage is creditable.
- CHIP: The Annual Children’s Health Insurance Program (CHIP) notice is required for states providing premium subsidies.
- WHCRA: Health plans and issuers must provide a notice of participants’ rights to mastectomy-related benefits under the WHCRA at the time of enrollment and on an annual basis. The DOL’s compliance assistance guide includes model language for this disclosure.
Employers should also ensure that at least one health plan option satisfies the ACA’s affordability standard for 2026 and that all plans comply with relevant out-of-pocket maximums.
Helping Employees Make Informed Decisions
To support employees in making the best choices for their situations, consider these approaches:
- Encourage employees to review their medical history and anticipate health needs for the coming year
- Provide tools to help employees compare different plan options based on their specific circumstances
- Explain how rising healthcare costs might affect premiums and coverage
Clarify the consequences of missing open enrollment deadlines and offer resources to help employees understand qualifying life events that would allow changes outside the open enrollment period. By offering guidance without overwhelming employees, organizations can foster a more engaged and satisfied workforce that better utilizes their benefits.
Final Thoughts
The 2026 Open Enrollment period presents both challenges and opportunities for employers and employees. But with thoughtful planning and clear communication, you can turn this annual process from an obligation into a valuable opportunity for employees to secure their health and financial well-being.
Remember that effective benefits administration doesn’t end with open enrollment. Ongoing communication throughout the year helps employees fully utilize their benefits and appreciate the value your organization provides, contributing to higher satisfaction and retention rates.
For additional support with your open enrollment strategy, contact your benefits advisor or broker.
