Sheer Health Guide to Open Enrollment

Open enrollment is your once-a-year opportunity to review, adjust, or change your health insurance plan, typically occurring in the fall. Your HR or Benefits team usually notifies you when open enrollment begins, giving you just a few weeks to choose a new plan. Surprisingly, many people let this critical period pass without reviewing their benefit usage or health spending from the past year—missing out on opportunities to significantly lower healthcare costs for the new plan year. Here’s how you can save money during open enrollment without sacrificing the healthcare you need.

Sheer Health offers a free Health Plan Analysis that provides personalized insights into your benefits usage and healthcare expenses, helping you make the best choice for your 2025 plan. This analysis can highlight areas where you’re overspending, giving you the chance to adjust to a plan that better fits your needs and saves you money.

If you miss this window, you might be stuck with a more costly or less effective plan until the next open enrollment period—unless you experience a qualifying life event, such as a new job, marriage, or the birth of a child.

Sheer Health helps you maximize this opportunity by delivering tailored insights, ensuring you select the most cost-effective plan that aligns with your family’s healthcare needs. With Sheer, you can reduce your healthcare expenses while enjoying better coverage for the new plan year. We analyze medical, dental, vision and prescription claims to help you pay less for care!

Who Uses Open Enrollment?

• Employer-Provided Insurance: Review or change your health benefits through your employer during this period.
• Medicare: If you’re on Medicare, open enrollment lets you adjust your Medicare Advantage or prescription drug plan.
• Marketplace: For those purchasing insurance through the Affordable Care Act, this is your annual opportunity to change or modify your health coverage.

Why It’s Crucial to Understand Your Benefits Usage

Understanding how you’ve used your health insurance benefits in the past year is key to selecting the right plan for the upcoming year. By reviewing your medical claims, out-of-pocket expenses, and coverage usage, you’ll gain insights into which new plan is right for you..

Key reasons to evaluate your benefits usage:

• Optimize Coverage: If you’ve consistently underutilized certain services, you may be paying for coverage you don’t need.
• Prepare for Future Medical Costs: If you anticipate changes in your health or family situation, such as surgeries, a new baby, or increased prescription use, adjusting your plan could save you thousands.
• Maximize Out-of-Network Reimbursements: Plans vary significantly in how they handle out-of-network providers. Understanding this can ensure you’re not leaving money on the table for reimbursements.

By analyzing your previous year’s claims and projected needs for the coming year, Sheer Health helps you choose the best health plan for your specific healthcare needs, saving you time, money, and stress.

Sheer Health Plan Analysis

For the 2025 Open Enrollment season, Sheer Health offers Medical Insurance Plan Analysis to help you make informed healthcare decisions. Our Plan Analysis includes comprehensive reports with side-by-side comparisons, detailed cost breakdowns, and personalized insights, so you can select the plan that best suits your needs.

Choose from Two Analysis Options:

• Standard Analysis: FreeGet a personalized summary highlighting the best health insurance plan based on your past claims, premiums, and key insights for better coverage decisions.
• Premium Analysis: $89Receive an in-depth report detailing in-network vs. out-of-network costs, projected reimbursements, and expected out-of-pocket expenses. This analysis also considers life events like family changes or surgeries to give you tailored recommendations.

What You’ll Need to Start:

• Your plan document or benefits guide (required)
• Information about upcoming medical considerations
• Monthly premiums for your current plan(s)

How to Find Your Plan Documents:

• Employer-based plans: Check your company’s intranet or contact your HR department.
• Non-employer based plans: Visit the Health Insurance Marketplace (healthcare.gov) or your state’s exchange for details.

What happens if you’ve missed Open Enrollment

You have approximately 45 days to shop and enroll in plans. After that, only a Qualifying Life Event will make you eligible for a Special Enrollment Period. Otherwise, you will have to wait a full calendar year to change your health insurance plan.

Qualifying events include:

• Changes in Household
  • Marriage or divorce
  • Having a baby or adopting a child
  • Death of someone on your insurance plan
• Changes in Residence
  • Moving to a new ZIP code or county
  • Moving to the U.S. from a foreign country
  • Moving to or from a shelter or transitional housing
• Loss of Health Coverage
  • Losing job-based coverage
  • Losing eligibility for Medicare, Medicaid, or CHIP
  • Losing individual coverage (including COBRA)

Let Sheer Health simplify your 2025 during open enrollment. We’ll help you lower your out-of-pocket healthcare costs and get the most out of your new health plan.