Your Guide to Open Enrollment: Choosing the Right Benefits (Physicians and High Earners)
Open enrollment rolls around every fall, usually in October or November. If you work on an academic calendar, it might show up earlier. Either way, this is your annual opportunity to review, adjust, and update your benefits. It matters more than it looks at first glance. You can set up your health care, protect your income, boost retirement savings, and snag hidden perks that save you real money. You’ll get a clear checklist to follow each year, simple rules for picking plans, and a smarter way to use HSAs and FSAs without leaving cash on the table.
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Understanding Open Enrollment Basics
Open enrollment is the brief window when you review and select workplace benefits for the upcoming year. It is a popular time of year for reviewing and selecting workplace benefits. Most employers run it in the fall, and some run it earlier for academic schedules.
Here is what falls under that umbrella:
- Health insurance plans and HSA/FSA options
- Disability and life insurance
- Retirement plans and contribution types
- Commuter perks and professional benefits
This is your chance to update choices for you and your family; do not rush it.
The goal here is simple: build a repeatable system you can use every year. You will look back at what worked, plan for what is ahead, and make smart updates without spending all day on it.
Steps to Prepare for Open Enrollment Every Year
Review What Happened Last Year
Start with a quick audit. What did you pick last year, and how did it go? Review your benefits, check claims, and examine your spending.
Ask yourself:
- Did your health plan cover what you expected, or did any bills surprise you?
- How much was left in your FSA at year’s end?
- Did you open benefits like commuter or legal services but never use them?
Use what happened to guide this year. If you’ve already maxed out your healthcare FSA, consider increasing it. If you forgot about the dependent care FSA, dial it down to a safer number.
Assess Current Benefits and Future Needs
Now look at the set of benefits for the upcoming year. Every plan changes a bit. Costs shift, networks move, and new features pop up.
Consider:
- Family goals, like childcare, fertility, or adding a dependent
- Career moves, like changing employers or joining a partnership
- Financial priorities, like paying down debt or saving more for retirement
Start slowly with uncertain benefits like FSAs to avoid losing money.
Account for Major Life Changes
Big changes coming next year? Pregnancy, an upcoming procedure, or welcoming a new family member all point to beefing up health coverage and reviewing dependent care options. Plan for what you already know is coming.
Align Benefits with Your Goals and Document Choices
Tie your decisions to your life and money goals. Then write it down. Keep a simple note on what worked, what did not, and what to change. It does not have to be fancy. A note that says “childbirth next year, pick a stronger plan” or “ran out of FSA by September” is gold when this season comes around again. Documenting saves time next year and keeps you from having to start over.
Choosing the Right Health Insurance Plan
Health insurance is the big one. It is also where mistakes can be most costly. The best plan for you depends on your expected care, prescriptions, and the level of risk you are willing to take with deductibles.
Understanding Plan Types: Navigating the Alphabet Soup
Here is a fast breakdown you can use:
| Plan Type | What it means | Pros | Cons | Good fit when |
|---|---|---|---|---|
| HMO | You pick a primary care doctor and stay in network | Lower premiums, simpler | Less flexibility | You like coordinated care and your doctors are in-network |
| PPO | More freedom to see specialists without referrals | Flexible, broad networks | Higher premiums | You want choice and expect some specialist visits |
| HDHP | High deductible health plan, often HSA-eligible | Lower premiums, HSA access | Higher out-of-pocket before coverage | You want long-term tax benefits and expect low care this year |
As a physician or high earner, you get the stakes here. Pick based on real needs, like known procedures or recurring prescriptions, not just the premium number.
When to Choose a Cadillac Plan vs. a High Deductible Option
Some years call for the top plan. If you expect childbirth, surgery, or ongoing treatments, a richer plan can be worth it. Other years look quieter. That is when a high deductible health plan paired with an HSA can shine.
Watch for:
- Planned procedures next year
- Prescription costs for you or your family
- Your ability to cover a deductible out of pocket
- Network changes that affect your current doctors
Large medical bills still rank among the biggest reasons people end up in financial stress. Plan ahead and protect yourself.
Pro Tip: Pair with HSA Eligibility
If you pick an HDHP, confirm with HR that it is HSA-eligible. That unlocks a powerful tax tool you will want to use next.
Maximizing HSAs and FSAs for Tax Savings
These two are often overlooked, which is surprising because they can put real money back in your pocket. If you are in a higher tax bracket, the savings stack up even faster.
Flexible Spending Accounts (FSAs): Healthcare and Dependent Care Basics
There are two flavors:
- Healthcare FSA: For qualified medical costs.
- Dependent Care FSA: For childcare and similar expenses.
FSAs are usually use it or lose it. Some employers allow a small carryover or a short grace period. Get the rules for your plan. If you’re unsure how much you will spend, start small and adjust next year.
Bold advice if you are unsure: start lower, not higher. It is better to add next year than to let money expire.
Quick tips:
- Pre-tax savings add up fast when your tax rate is high.
- Check your plan rules if you want to use an FSA alongside an HSA.
Example: You think you will spend 2,000 dollars, but you are not certain. Start with $ 1,000, track actual costs, and adjust it next year.
Health Savings Accounts (HSAs): The Long-Term Powerhouse
HSAs are only available if you enroll in an HSA-eligible HDHP. If that is you, this account is a unicorn. You receive a tax deduction upfront, tax-free growth, and tax-free withdrawals for qualified medical expenses.
Smart move: Contribute to the HSA, then invest the funds. Let them grow for decades. Pay smaller medical bills out of pocket if you can, and save the receipts. You heard me right, you can keep the HSA invested for years.
Here is the strategy in plain English: cover today’s costs yourself so your HSA can compound quietly in the background. Future you will thank present you.
Rules and Compatibility Between HSA and FSA
Using both can get tricky. Some plans require a limited-purpose FSA if you have an HSA, which only covers dental and vision. Ask HR or your planner before you commit. A simple rule of thumb: HSAs require an eligible HDHP, FSAs do not.
Securing Disability and Life Insurance During Open Enrollment
Insurance talk is not thrilling, but it is where you protect everything you are building. Take a few minutes here, and you will sleep better in the future.
Disability Insurance: Group vs. Private Options
If you don’t have private disability coverage yet, consider the employer plan. If your employer offers a free base plan and a low-cost supplement, those can be useful. For many people, that is the right call.
If you are a physician or a high earner with a specialized skill, you have a wrinkle to consider. Private disability policies can offer stronger definitions, such as true own-occupation, that pay benefits if you are unable to perform your specific medical specialty. That can be a big deal.
Consider this:
- Group coverage: Often cheaper or free, but definitions can be weaker, and benefits may be taxable if employer-paid.
- Private coverage: Stronger terms, better for specialties, but more expensive.
Here is the key point: group coverage can limit the amount of private coverage you are allowed to purchase. Run the numbers with someone who can compare both paths. Additionally, some employers do not allow you to opt out of group coverage. In that case, you just plan around it.
Life Insurance: Grab the Freebies and Evaluate Needs
If your employer offers free life insurance, take it. No debate. If anyone relies on your income, add more coverage. That includes a spouse, kids, or family you support back home.
Term life policies on the private market are often affordable if your health is good. They are portable, which means you keep the coverage even when you change jobs. Group life is fine, but it may not follow you.
Simple gut check:
- Who depends on your income?
- How long would they need support?
- What debts or big expenses need covering?
If health is an issue, group coverage may be your best option. If health is solid, a private term policy can lock in a good rate and travel with you.
Optimizing Your Retirement Plan Contributions
Open enrollment is also a great time to tune your retirement savings. A small boost today can create a big gap later.
Aim to Max Out: Steps for High-Income Earners
If you can, max out your 401(k) or 403(b). If that is not possible this year, bump your percentage. Going from 5 percent to 7 percent is a win. Keep nudging it up over time.
Working in academic medicine? See if you have access to a 457(b) on top of your 403(b). That is another tax-deferred bucket that can help you save more.
You have probably heard the joke, but it holds up: no one calls from retirement to complain they saved too much.
Pre-Tax vs. Roth: Which Fits Your Bracket?
As a broad rule, higher tax brackets tend to favor pre-tax contributions. Lower brackets often benefit from Roth. The right mix depends on your current rate, future expectations, and plan options.
Look for Mega Backdoor Roth Opportunities
Scan your enrollment materials for after-tax contributions and in-plan conversions. If your plan supports them, you might be able to do a mega backdoor Roth. That can supercharge your savings. Ask HR about any new plan features or changes. Those updates are usually listed right up front.
Uncovering Other Valuable Benefits
The headline benefits get most of the focus. Do not forget the extras that quietly save money or fund your growth.
Commuter Benefits: Save Pre-Tax on Your Daily Ride
If you pay for buses, trains, or subways, commuter benefits can cut your costs using pre-tax dollars. It is especially helpful in big cities or if your commute is pricey. Simple, boring, effective.
Education and Professional Perks
Many employers offer professional development money. Do not skip it.
- Continuing education reimbursements
- Professional association dues
- CME budgets for physicians
These are easy wins. They support your career and keep more money in your pocket. These add up over a year, especially when you stack them with the big items.
A Quick Annual Checklist You Can Reuse
- Review last year’s costs and usage
- Map any life changes coming next year
- Compare health plan networks, premiums, and deductibles
- Decide on HSA or FSA amounts based on real numbers
- Lock in disability and life coverage that fits your situation
- Increase retirement contributions and scan for new plan features
- Add commuter, education, and other hidden perks
Conclusion
Open enrollment is not a set-and-forget chore. It is your annual reset. Review last year, plan for next year, and pick the options that fit your life right now. Take your time, stay organized, and write down what worked so next year is even easier. Your future self will be glad you handled this season with a plan.
Looking for a more thorough all-in-one spot for your financial life? Check out our free eBook: A Doctor’s Prescription to Comprehensive Financial Wellness [Yes, it will ask for your email 😉]