Even if you keep the same health insurance, your coverage may not stay the same. Premiums, deductibles, provider networks, prescription coverage, and other benefits can change each year. Your needs may change, too—whether you started a new job, added a family member, are planning medical care, or are approaching Medicare eligibility.
As Clay Dean, CEO of First Mid Insurance Group, explains:
“When it comes to something as important as your health, people want human expertise, advice, and most of all, a human touch that artificial intelligence (AI) cannot provide.”
That guidance can be especially valuable when comparing costs and coverage. Reviewing your plan annually can help you avoid unexpected expenses and choose benefits that better support your health and budget. Start with these five steps.
1. Calculate Your Total Healthcare Costs
Your monthly premium or paycheck deduction is only one part of your healthcare costs. To estimate what your coverage may cost, review:
- Annual premiums: This is what you pay to keep your coverage. Multiply each payment or payroll deduction by the number of payments you make each year.
- Deductible: This is what you may pay for certain services before your plan begins paying its share.
- Copays and coinsurance: A copay is a set amount; coinsurance is a percentage of the cost. Check what you could pay for common services and prescriptions.
- Out-of-pocket maximum: This is the most you may pay for covered, in-network care during the plan year.
- Employer HSA contributions: If applicable, factor in any money or matching funds your employer contributes to help offset eligible healthcare expenses.
- Individual and family costs: If you cover family members, check how the plan’s individual and family deductibles and out-of-pocket limits apply.
- Costs outside the limit: Premiums, out-of-network care, and non-covered services generally do not count toward your out-of-pocket maximum.
Estimated annual cost = annual premium payments + expected out-of-pocket costs − employer HSA contributions
Ask yourself: Would a plan with a higher premium but lower costs when you receive care provide better value? Or would a lower-premium plan better fit how you expect to use your coverage?
2. Confirm Your Trusted Providers Are in Network
A provider may accept coverage from an insurance company without participating in every plan it offers. Verify that your preferred providers and facilities are in network for your exact plan by checking with both your insurer and the provider.
Planning a procedure? Confirm that the facility and professionals involved are in network and ask whether you need a referral or prior authorization.
3. Review Your Prescriptions & Ways to Save
Medication coverage and prices can change. Check each regular prescription and compare:
- Preferred in-network pharmacies
- 90-day fills or home-delivery programs
- Generic or other lower-cost alternatives
- Manufacturer discounts or patient-assistance programs
- Discount-card or cash-price programs
4. Plan For the Care You Expect to Use
Think ahead about the care you and your family may need, including ongoing treatment and planned procedures.
If you have an HSA-eligible health plan, review your contribution based on expected expenses, employer contributions, your current balance, and longer-term savings goals. If you have an FSA instead, check your contribution amount, spending deadline, and rollover rules.
Planning your HSA contributions? First Mid offers HSA calculators and resources that can help you explore contribution limits and prepare for current and future healthcare expenses.
5. Ask For Help Before Deciding
Plan details aren’t always easy to compare. A First Mid Insurance agent can explain how differences in costs, networks, prescriptions, and benefits may affect your care and budget.
If you have Medicare or are approaching eligibility, our Medicare insurance agents offer complimentary, no-obligation coverage reviews during the Annual Enrollment Period. Even if your current plan works well for you, a review can help you understand upcoming changes and confirm that your coverage still fits this stage of your life.
“I was preparing to retire and go onto Medicare, knowing that I needed a major surgery after retirement. I came to First Mid Insurance Group, who paired me with a policy that covered the cost of this expensive surgery. The expertise and service from their Senior Solutions team has been top notch and I have enthusiastically recommended them to numerous friends and family.”- Dennis Terry
Wherever you are in your health insurance journey, reviewing your coverage before you need care can help you move forward with fewer surprises and greater confidence.
During Medicare Annual Enrollment, Watch for Fraud
Scammers may become more active during the Medicare Annual Enrollment Period (October 15 – December 7, 2026) as people compare plans and coverage. Medicare will never call to sell you anything. However, you may legitimately hear from an insurance agent you already work with or have authorized to contact you.
If you are unsure who is contacting you:
- Protect your Medicare number as carefully as your Social Security number, and don’t share it with an unverified caller.
- Be cautious of pressure to act immediately or click an unexpected link.
- Hang up and call the agent or insurance company using a verified phone number.
Report suspected fraud at 1-800-MEDICARE (1-800-633-4227) or through Medicare.gov.
Did You Know? September Is Life Insurance Awareness Month.
Life changes can affect more than your health coverage. Consider whether your life insurance still reflects the needs of those who depend on you and the financial commitments you want to protect.
For Insurance Professionals
First Mid Insurance Group CEO Clay Dean shared his perspective with Independent Agent magazine on changes shaping today’s health insurance market and how knowledgeable agents can help clients navigate rising costs and evolving coverage and the importance of healthcare education.
Insurance products and services offered through First Mid Insurance Group are not deposits or obligations of the bank, are not insured by the FDIC or any governmental agency, are not guaranteed, and may lose value.
We do not offer every plan available in your area. Currently, we represent 11 organizations which offer 67 products in your area. Please contact Medicare.gov(Opens in a new Window), 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.