Open Enrollment is here, and for most families it’s the only time all year to adjust coverage, switch plans, or rethink what you’re paying for. The problem is simple: most plans are confusing, overpriced, and full of fine print.

This guide breaks down how to compare your options step-by-step so you can pick a plan that actually fits your needs, and understand where Direct Primary Care (DPC) can simplify everything.

1. Start by Reviewing Your Current Plan

Before comparing new options, look closely at what you’re already paying for.

Check:

Monthly premium
Deductible
Copays and coinsurance
Out-of-pocket maximum
Specialist requirements
Any surprise bills from last year

Then review your personal experience:

Did you avoid care because the deductible was too high?
Were prescriptions covered?
Did you have trouble getting appointments?
Did your doctor stay in-network all year?

Understanding where your current plan failed, or worked, is the foundation for choosing something better.

2. Know Your Expected Healthcare Needs for Next Year

Think ahead:

Any planned surgeries or procedures?
New medications or ongoing treatments?
Chronic conditions that need regular monitoring?
New family members? (birth, adoption, aging parents)
How often you realistically use primary care or labs?

A plan that’s perfect for one year may be a waste the next. Anticipating needs prevents overpaying for coverage you don’t actually use.

3. Check the Provider Networks Carefully

This is where people lose the most money. For each plan you’re considering:

Confirm your primary care doctor is in-network.
Check any specialists you regularly see.
Look at urgent care and hospitals nearby.
Review out-of-network rules and costs.

Even one out-of-network visit can cost more than a year of premiums. Networks change often, never assume your current doctor stays covered.

4. Compare the Plan Types (HMO, PPO, EPO, HDHP)

HMO (Health Maintenance Organization)

Lower premiums
Must stay in-network
Usually requires referrals

PPO (Preferred Provider Organization)

Higher premiums
Out-of-network options
No referrals needed

EPO (Exclusive Provider Organization)

Middle ground
No out-of-network coverage
Usually no referrals

HDHP (High Deductible Health Plan)

Lowest premiums
Higher deductibles
Allows use of an HSA
Pairs extremely well with Direct Primary Care

Most families who value cost control and predictable access lean toward HDHP + Direct Primary Care. You keep protection for major events, but avoid the constant costs and restrictions of traditional plans.

5. Review Prescription Coverage (Formulary Lookups)

For every medication you use:

Check if it’s covered
Identify the tier (determines cost)
Compare copays or coinsurance
Make sure no medications were dropped from the new year’s formulary

Drug coverage changes frequently. A simple formulary lookup can prevent major unexpected costs.

6. Check Whether You Qualify for Marketplace Subsidies

If you purchase insurance through the New York Marketplace, your income may qualify you for:

Premium tax credits
Cost-sharing reductions
Lower deductibles and out-of-pocket limits

For many households, this reduces premium costs significantly. A lower-premium plan paired with DPC often delivers the best overall value.

7. Put It All Together: Choosing the Smartest Plan

Here’s the core logic:

Every family uses healthcare differently.
Most people do not need expensive full-coverage plans.
Many routine healthcare needs (labs, imaging, medications) are often cheaper outside the insurance system.
You should still carry coverage for major or catastrophic events.
The goal is simple: avoid overpaying for care you rarely use while maintaining protection for emergencies.

This is exactly why so many families pair an HDHP with Direct Primary Care.

8. Where Direct Primary Care Fits In

Direct Primary Care replaces the uncertainty of insurance-based primary care with consistent, personal access.

With a Homesteady Health membership, you get:

Unlimited visits
Same or next day appointments
As long as you need them visits
Chronic condition support
Urgent care access
No copays, no deductibles, no surprise bills
Direct text, call, or telehealth access
A healthcare provider who knows you and follows you through your care

DPC covers 80–90% of your everyday healthcare needs.

When combined with a high-deductible or catastrophic plan, you get:

Protection from major emergencies
Extremely low monthly costs
Real access to your provider year-round
Predictable, transparent healthcare

For many families in the Ithaca and Trumansburg area, it’s the most affordable and practical setup.

9. Want Help Reviewing Your Options?

If you want a second pair of eyes on your plan, or want to see how Direct Primary Care fits your situation, you can schedule a quick call with Homesteady Health.

No pressure. No sales pitch. Just a clear explanation of your best options.

Call 607-882-6001 to get started.

Or Contact Us Here

The Step-by-Step Guide to Choosing the Right Health Plan This Open Enrollment (and How Direct Primary Care Fits In)