Open Enrollment 2026 Checklist: How to Choose Between HDHP and PPO Step by Step
Open enrollment is the one time each year you can change your health plan without a qualifying life event. Most people spend less than 30 minutes on this decision — for something that affects thousands of dollars in annual spending. This step-by-step checklist walks you through the complete process of evaluating HDHP vs PPO, from gathering your plan documents to handling account transitions.
Most employer open enrollment periods run in October or November for a January 1 effective date. ACA Marketplace open enrollment runs November 1 through January 15. Do not wait until the deadline — give yourself time to gather information, run the numbers, and make a confident decision. This is one of the highest-ROI 30 minutes you will spend all year.
Gather Your Plan Documents
Find the Summary of Benefits and Coverage (SBC) for both the HDHP and PPO options. Look for these numbers: monthly premium (your share), annual deductible, out-of-pocket maximum, coinsurance rate, copay amounts (PPO), and employer HSA contribution (HDHP). These are usually available in your benefits portal under Plan Documents or Benefits Summary.
Estimate Your Medical Spending
Review your last year's Explanation of Benefits (EOB) statements to see what you actually spent. Factor in: planned doctor visits, ongoing prescriptions, any expected procedures (surgery, dental work, therapy), whether you are planning a pregnancy, and new medications or specialist referrals. Be honest — most people overestimate or underestimate by 30-50%.
Run the Calculator
Enter your actual plan numbers into our HDHP vs PPO break-even calculator. It factors in premium differences, out-of-pocket costs, HSA tax savings, employer HSA contributions, and 5-year HSA investment growth. Try both your expected spending level and a worst-case scenario.
Consider Life Changes in the Coming Year
Life changes can dramatically shift the HDHP vs PPO maths. Are you planning a pregnancy? Starting a new medication? Getting married (adding spouse to plan)? Expecting a child to need braces? Planning surgery? Each of these scenarios has a different optimal plan choice.
Evaluate the HSA Opportunity
If choosing HDHP, decide where to open your HSA, how much to contribute (aim for the $4,400 individual or $8,750 family max), and how to invest the balance. If your employer's HSA provider charges fees, contribute through payroll for FICA savings and periodically transfer to Fidelity or Lively ($0 fees).
Handle Account Transitions
Switching from PPO to HDHP: spend down your FSA before the plan year ends. Any carryover may delay HSA eligibility. Switching from HDHP to PPO: your HSA balance stays. You can still spend from it, just cannot contribute. Consider maxing your HSA contribution in the final HDHP month.
Key Dates and Deadlines
Check with HR for your specific dates. Typically 2-4 weeks.
For 2026 coverage through Healthcare.gov or state exchanges.
Enrol by this date for coverage starting January 1, 2026.
Most employer plans and marketplace plans take effect.
Last day to enrol for 2026 marketplace coverage (Feb 1 start).
You can make prior-year HSA contributions until the tax filing deadline.
Qualifying Life Events (Mid-Year Plan Changes)
Outside of open enrollment, you can only change plans if you experience one of these qualifying events. You typically have 30-60 days from the event to make changes.
Note: Pregnancy is NOT a qualifying life event. However, the birth of the baby IS, which allows you to change plans within 30-60 days of delivery.
Frequently Asked Questions
When is open enrollment for 2026?
Most employer open enrollment periods run in October or November for a January 1 plan start date. ACA Marketplace open enrollment runs November 1, 2025 through January 15, 2026 for 2026 coverage. Check with your HR department for your specific employer's dates, as they vary.
Can I switch from PPO to HDHP during open enrollment?
Yes. Open enrollment is the time to switch between plan types. If you have an FSA, you need to spend down the balance before switching to an HDHP, as a general-purpose FSA disqualifies you from HSA contributions. An FSA carryover (up to $680) can also create HSA eligibility issues — check with your benefits administrator.
What happens to my HSA if I switch to PPO?
Your HSA balance is yours forever, regardless of your plan type. If you switch from HDHP to PPO, you keep your existing HSA, it continues to grow through investments, and you can still spend from it on qualified medical expenses. You simply cannot make new contributions while on a non-HDHP plan. This is actually a common strategy: build up the HSA during HDHP years, then spend from it during PPO years.
What happens to my FSA if I switch to HDHP?
If you switch from PPO (with FSA) to HDHP (with HSA), you must spend your FSA balance before the end of the current plan year. Any FSA carryover amount ($680 max) carries into the new year and may prevent HSA contributions until exhausted. The cleanest approach: elect $0 FSA for your final PPO year, spend remaining funds, then start fresh with an HSA.
What is a qualifying life event that allows mid-year plan changes?
Qualifying life events include: marriage or divorce, birth or adoption of a child, death of a spouse or dependent, losing other health coverage (job loss, aging off parent's plan), moving to a new state, and gaining citizenship. Each event typically gives you 30-60 days to make plan changes. Pregnancy alone is NOT a qualifying life event, but the birth of the baby is.