Open Enrollment 2025: What to Know

Open enrollment season is approaching. Here's what benefits professionals should be thinking about as they prepare for 2026 plan year decisions.

Cost Context

Healthcare costs continue their upward trajectory, but the story is nuanced:

What's pressuring costs:
• Specialty pharmacy, particularly GLP-1 medications
• Provider rate increases reflecting labor costs
• Utilization returning to pre-pandemic levels
• High-cost gene therapies and cancer treatments

What's moderating costs:
• Telehealth reducing some unnecessary ED visits
• Improved chronic disease management
• Biosimilar adoption (where available)
• Site-of-care optimization

Net result: expect mid-to-high single-digit cost increases for most employers.

Key Decisions

GLP-1 coverage: If you haven't addressed GLP-1 medications explicitly, now is the time. Develop a clear policy—whether that's coverage with management, restricted coverage, or exclusion—rather than handling case-by-case.

Mental health adequacy: Are your mental health benefits keeping pace with employee expectations? EAP visits, telehealth access, and digital tools are all areas to evaluate.

Contribution strategy: After years of shifting costs to employees, are you at a sustainable equilibrium? Or is it time to adjust contributions to remain competitive?

Voluntary benefits menu: Review your voluntary offerings. Are there gaps? Are participation rates healthy? Is the menu overwhelming or well-curated?

Communication Planning

Open enrollment success depends on communication:

Start early: Employee communication shouldn't begin at open enrollment. Year-round benefits education improves enrollment decisions.

Simplify choices: If employees face complex decisions, provide decision support tools. Paradox of choice leads to poor decisions or non-decisions.

Highlight what's new: Any changes—positive or negative—should be clearly communicated. Surprises breed distrust.

Emphasize total value: Help employees understand the full value of their benefits, not just what they pay.

Competitive Positioning

Use open enrollment as an opportunity to assess competitiveness:

• How does your plan design compare to peers?
• Are your contributions competitive?
• What are you offering that competitors aren't?
• Where are you vulnerable to losing talent?

Benchmarking data informs these questions. If you haven't benchmarked recently, do it before finalizing OE decisions.

Looking Ahead

Open enrollment isn't just about next year—it's about building a sustainable benefits strategy. Make decisions that position you well for 2026 while setting up for the years beyond.