Your annual review, and why auto-renewal is not enough

If you do nothing during Open Enrollment, you are generally re-enrolled into the same plan, or something close to it if yours is no longer offered.

That is convenient and it is not the same as a decision. Three things change every year, and auto-renewal accounts for none of them.

What changes without you

The plan. Premiums, deductibles, out-of-pocket maximums, networks and drug formularies are all rebuilt for each plan year. The plan you are renewed into in January is not quite the plan you chose.

The market around it. Carriers enter and leave counties. A better fit may have appeared, or your carrier may have withdrawn, in which case you have been moved into something you did not choose.

Your credit. The premium tax credit is calculated against a local benchmark plan, which is re-set each year. Your credit can change even when your income has not — and if the benchmark moves, what you pay can move noticeably.

And separately: you change. A new prescription in March, a specialist added in July, a different income, a child who has left the household.

The checklist

Half an hour, once a year, in October.

1. Read the notice from your plan. It arrives before the year starts and says what is changing about your coverage. It is dull and it is the only individual warning you get.

2. Update your income estimate. For the coming year, for everyone on your tax return. This is the number the credit hangs on and it is the one people carry forward unthinkingly.

3. Re-check your doctors by name. Networks are rebuilt annually. Search the directory, then telephone the practice’s billing office and ask whether they are contracted for the coming plan year. Ten minutes, and it prevents the most common regret.

4. Re-check your medications by name and strength. Tiers move, restrictions get added, drugs leave formularies. Enter your list on HealthCare.gov and compare the annual cost rather than the monthly premium.

5. Check whether Silver plans are showing a reduced deductible. If your income falls in the right range, cost-sharing reductions apply only to Silver, and they are worth more than the premium difference that tempts people towards Bronze.

6. Look at the plans you did not choose last year. The market is not the same market.

Then decide, including deciding to stay

Most years, for most households, the answer is to change nothing. That is a perfectly good outcome — the point is that you stayed on purpose rather than by default.

If something has changed enough to matter, Open Enrollment is when you can act on it without needing a qualifying event.

During the year, not just in the autumn

Report changes when they happen. A raise, a job change, a marriage, a birth, someone joining or leaving your tax household. The credit adjusts going forward, which keeps the tax-time reconciliation small. Leave it all to December and the settlement can be uncomfortable.

Tell us when a doctor adds an expensive prescription. It does not change your plan mid-year, but it changes what we should be looking at in October.

What we do

If we placed your plan, we re-run your medication list and your doctors against the coming year’s plans every autumn, whether or not you ask, and tell you whether anything warrants changing. There is no charge, and most years we tell people to stay put.

An agency that finds a reason to move you every year is generating commission, not advice.

Where to get help

HealthCare.gov compares every plan available in your county with your credit applied. The Marketplace Call Center is on 1-800-318-2596, TTY 1-855-889-4325, free and open at any hour — including through the busiest weeks of Open Enrollment.

Navigators and certified application counselors give free in-person help and are not paid by insurance companies: localhelp.healthcare.gov.

Half an hour in October is the whole annual maintenance schedule. Almost everybody who gets caught out in January skipped it.