Dig. Health | Open Enrollment

Dignity Health Guide to Open Enrollment: Tips to Make Sure You Get the Coverage You Need

By Monica Vanover on September 3, 2025.

Fall is here! That means it’s Open Enrollment season. Open Enrollment is the all-important annual window when consumers can enroll in or adjust their health insurance coverage without special circumstances or a qualifying life event. Not satisfied with your doctor? Starting a family? Have an emerging medical condition? Now is the time to evaluate your benefits! Choosing new health insurance or switching to a different plan can feel overwhelming. It takes time and effort. But it’s an important step toward ensuring you and your family have a healthy and happy 2026. “Taking advantage of Open Enrollment is important because health care needs can arise at any point,” says Dr. Khuram Arif, President of Western Health Advantage, a health plan created by doctors and hospitals, including Dignity Health. “When people get sick, they need to know they've got a care team they trust and access to a strong hospital system with good specialists who can take care of any kind of health care need.” To help you choose the right health insurance, here’s your Open Enrollment Guide, courtesy of Dignity Health.

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6. Know what matters to you. Finding the right health insurance depends on knowing what matters to your health. For example, a person with a chronic condition like high blood pressure or diabetes needs a different level of care than a person without a chronic condition. If you have kids, you’ll likely want access to a strong pediatrics program. If you have a rare condition, being part of a network that specializes in complex care can make a huge difference. Ask yourself what your health needs are and prioritize. Don’t forget other factors that may be important to you like travel distance or the number of locations! 7. All health plans are not created equal. How your health plan is managed is crucial to your well-being. A health plan from Western Health Advantage benefits from the fact that they are jointly owned by Dignity Health and local to Northern California. According to Dr. Arif, this provides clear advantages to its patients.

“The value of having a health insurance plan that's owned by the health systems is that those doctors in the health systems are part of our quality committees and help make important decisions on patient care, like what kind of benefits to offer to our patients,” says Dr. Arif. “Our philosophy at Western Health is to allow providers to make decisions. Medical decisions should be made by providers, not insurance companies. We believe in getting out of the way so that patients can receive the best care possible.” As a passionate advocate for patient autonomy and clinical providers, Dr. Arif spent 20 years in pediatrics before joining WHA to help connect patients with Dignity Health’s award-winning doctors and nationally recognized hospitals. “When you work in patient care, you are blessed to help one patient at a time,” he says. “By also working with a health plan, I can now contribute to programs that will help 10,000 people at a time."

In California, there are plenty of options for getting health care, from enrolling through the state-run marketplace Covered California to enrolling through your employer. Regardless of how you get your health insurance, Dignity Health is there to help guide you through the process. Learn more about Dignity Health at dignityhealth.org/OpenEnrollment Learn more about Western Health Advantage at westernhealth.com Now that you understand Open Enrollment, it's time to think about selecting a doctor and being proactive about your health. Read our story The Key to Both Quality and Longevity of Life is Primary Care. Here's Why to explore further.

1. Start early. Open Enrollment is a great opportunity to ensure your health care needs will be covered for the next calendar year, but to adequately take advantage of it, you need plenty of time. “Choosing a health plan is an important decision that you don’t want to rush,” says Dr. Arif. Dr. Arif recommends consumers begin researching one month before the start of Open Enrollment. Different carriers, plans, and employers have different Open Enrollment periods. For example, Open Enrollment for Covered California, the state's insurance marketplace, is from November 1st through January 31st while many employers offer Open Enrollment over a few weeks in October or November. 2. Understand terms. Don’t go into your search without first understanding the terms. “Insurance terminology can be confusing,” Dr. Arif admits. “Before your search, make sure you know what kind of insurance you need, for example, whether you need an HMO or PPO. PPOs tend to be more expensive because they operate on a larger network of providers but in Northern California where health care tends to be more concentrated, HMOs offer great networks at a better price.” 3. Ask questions. If you get your health insurance from your employer, talk to your Human Resources representative and find out when your Open Enrollment period is. Ask what changes have been made to your options, including benefit updates, and if there are increased or decreased costs to you. If you purchase your health plan on your own, visit Covered California for information on important dates, the enrollment process, and health insurance options. If you have further questions, reach out to an expert, like an insurance broker. Also, speak with your family and friends to get their opinions on plans and doctors they’re familiar with. 4. Plan ahead. Many people choose a health insurance plan based on their current needs. However, it is important to plan ahead to anticipate what your family’s medical needs may be in the coming year. “Health care needs change over time,” explains Dr. Arif. “For instance, if you're expecting a new baby, you want to make sure that you've got a pediatrician lined up, and a good OBGYN lined up for the mom. It's also important to make sure the doctor you're looking to choose is taking new patients. Finally, you’ll want to make sure these doctors are covered by the plan you choose.” Elective surgeries, pregnancies and chronic conditions all have an impact on your health care choices. These considerations can affect which plan you choose and, if your employer offers a flexible spending account (FSA), how much money you need to set aside. Also, if you take any prescription drugs, you’ll want to check to see if they are covered by the plans you are considering. 5. Compare plans! Health plans vary significantly in price and value. Depending on your health needs, the plan that’s right for you might not be right for someone else. Key elements to compare include:

“Choosing a health plan is an important decision that you don’t want to rush."

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The monthly premium is the amount you pay each month to keep your insurance active. Out-of-pocket costs are expenses outside of your monthly premium that you pay directly for medical care. These include deductibles, copays, and coinsurance, and they must be paid until reaching the plan's out-of-pocket maximum. After reaching this maximum, your insurance typically pays 100% of covered medical costs for the rest of the policy period. Deductibles are the amount you pay for covered expenses before your health plan starts to pay its share. The amount can vary depending on factors like your premium and the plan type (HMO, PPO, etc.). In most cases, the higher the deductible, the lower the monthly premium, which is great for those who are generally healthy and don’t require frequent medical care. Inversely, the lower the deductible, the higher the monthly premium will be. In this case, you’ll pay less out-of-pocket before your plan starts paying. This is a good choice if you have a condition that has you receiving care frequently. When deciding between plans with high or low deductibles, it's important to consider your budget and anticipated medical expenses for the next year. Covered benefits can include routine care, preventive screenings, mental health or prescription drugs. In-network providers are doctors, facilities, pharmacies, and suppliers that a plan contracts with to provide services to its members.