10/13/2026
Open enrollment is about a lot more than finding the lowest monthly premium. A few other things I want families to know:
š If anyone in your family takes regular medications, check the formulary.
Prescription coverage isnāt simply an HMO vs. PPO issue. Every plan has its own formulary, tiers, prior authorizations, and preferred medications.
This is especially important with expensive or chronic medicationsāgrowth hormone, certain ADHD medications, biologics, newer diabetes/weight-management medications, and other specialty drugs.
And donāt assume that because a medication was covered this year, it will be covered the same way next yearāļø
Formularies change. A medication youāve taken for years can suddenly require prior authorization, become non-preferred, or cost hundreds of dollars.
If a medication matters to your family, look it up before choosing the plan.
š° Having insurance doesnāt automatically mean using it is the cheapest option.
For routine bloodwork, a simple X-ray, and other bread-and-butter services, cash pricing can sometimes be significantly less expensiveāespecially with a high deductible.
Thatās another way DPC can work alongside insurance. We can use insurance for the bigger-ticket items where we really need it, while using transparent cash pricing for everyday healthcare when it saves you money.
š¦ Have an HSA or FSA? You can use those dollars for Direct Primary Care.
Starting in 2026, HSA funds can be used tax-free for DPC membership fees:
⢠Up to $150/month ā individual
⢠Up to $300/month ā family
Those are pre-tax healthcare dollars, which can mean meaningful tax savings on money youāre already spending on healthcare.
FSA funds can also be used for your DPC membership, but the rules for accessing those funds or getting reimbursed may vary from one employer to another. Check with your employer or FSA administrator for how to proceed.
šš»So during open enrollment, donāt just ask, āWhatās my premium?ā
šµš»āāļøLook at your network, medications, deductible, out-of-pocket maximum, and HSA/FSA options.
āļø Most importantly, think about how your family actually uses healthcareāand what you need from your plan to get the care you need. āļø
*Physician