Podcast Summary: "What You Need to Know for Open Enrollment"

Chasing Life – CNN Podcasts
Host: Dr. Sanjay Gupta
Guest: Dr. Elizabeth Rosenthal
Date: October 21, 2025

Episode Overview

This episode of Chasing Life dives into the often confusing and stressful process of open enrollment for health insurance in the United States. Dr. Sanjay Gupta is joined by Dr. Elizabeth Rosenthal, a physician, journalist, and health policy expert, to demystify the choices, explain terms, highlight pitfalls, and arm listeners with advice to make this annual process less daunting. Together, they answer key questions, tackle common misconceptions, and share strategies to help listeners make the best possible decisions for their health care coverage.

Key Discussion Points & Insights

1. What is Open Enrollment? (02:52–03:42)

• Definition & Purpose:
  • Open enrollment is the annual period where individuals can sign up for or renew health insurance plans.
  • Dr. Rosenthal: “It's one time of year because what the insurers don't want you to do ... is to go without insurance, get diagnosed with cancer and then go, oh, now I'm going to buy a really good plan.” (02:55)
• Timing: Generally begins November 1st across most states, with some variation.

2. Qualifying Life Events (03:42–04:46)

• Outside of open enrollment, only certain “qualifying life events” (marriage, divorce, job loss, having a baby, aging out of a parent’s plan) enable changes to health insurance.
• COBRA: Allows continuation on a company plan after job loss, but requires paying the full premium, which can be prohibitively expensive.

3. Where and How to Shop for Insurance (04:46–06:21)

• Marketplace Locations:
  • 32 states use the federal marketplace at Healthcare.gov; others have their own state-run sites.
  • Dr. Gupta: “Visit healthcare.gov and see if your state pops up.” (05:12)
• Navigators & Assistors:
  • Seek navigators—officially trained helpers (not sales-commissioned brokers)—to navigate plan choices.
  • Watch out for insurance brokers, who may steer you toward plans that benefit them more than you.

4. Networks & Providers: Doctor/Hospital Coverage (06:47–08:54)

• Always verify if your preferred doctors/hospitals are “in-network.”
• Networks can change yearly or even mid-year.
• Dr. Rosenthal:
  • “We shouldn't put so much responsibility on patients. I mean, it's so much detective work.” (07:20)
  • “The more choosy you are, the more you’re going to pay.” (08:27)
• Advice: Double-check names and locations of hospitals to ensure you’re covered at the right one (e.g., some hospitals have multiple locations).

5. State Marketplaces & Public Options (08:54–10:51)

• Marketplace Names: State exchanges may have unique names (“New York State of Health,” “MaineCare”).
• Public Options: Still rare; only a few states (e.g., Colorado, Oregon) offer them, and networks may be limited.

6. Consequences of Missing Open Enrollment (10:51–11:53)

• No Automatic Coverage: Not all plans roll over; some discontinue without notice.
• Vital Advice:
  • Dr. Rosenthal: “If you see a health care thing on an envelope, you should open it to see what it says.” (11:06)
• Some plans may end or change without clear warning, making vigilance crucial.

7. Short-Term Plans & Pitfalls (13:31–14:13)

• Short-term Plans: Not compliant with ACA standards, potentially lacking basics like pregnancy care, vaccines, and preventative coverage.
• Coverage can be highly limited, especially out-of-state.

8. Age 26 Rule—Young Adults & Insurance (14:13–16:43)

• Aging Off Parents' Plan: At 26, adults must leave family coverage.
• Original ACA intent: expanded Medicaid in all states and robust exchanges would cover gaps, but not fully realized.
• Result: Many 26-year-olds, especially gig workers, struggle with options.
• Memorable Moment:
  • Dr. Rosenthal shares, “One young woman said...I felt like throwing my head into my birthday cake and saying, I don't have health insurance. You know, it's not a happy birthday anymore.” (16:43)

Lightning Round: Glossary of Essential Terms (17:03–24:45)

HMO vs PPO (17:12–18:39)

• HMO: Limited network; must stay in-network (e.g., Kaiser), sometimes pejorative but not always bad.
• PPO: Broader coverage and flexibility, some out-of-network coverage, higher premiums.

HSA vs FSA (18:39–20:30)

• FSA (“Flexible Spending Account”):
  • Use-it-or-lose-it, set aside pre-tax dollars, limited time to spend.
  • “You find yourself at the end of the year like scrambling to like buy new sunglasses or over the counter medicines, whatever.” – Dr. Rosenthal (19:08)
• HSA (“Health Savings Account”):
  • Rolls over year-to-year, usually paired with high-deductible plans.
  • Limited annual contributions; unlikely to cover major medical costs alone.

Deductible vs Premium vs Copay vs Coinsurance (20:38–23:31)

• Deductible: What you pay before insurance kicks in; varies plan by plan.
• Premium: Monthly payment to have coverage; usually an inverse relationship with deductible.
• Copay: Fixed cost for specific services; usually small.
• Coinsurance: % of costs you pay even with insurance, “often 20% ... If you’re in the hospital for two days, 20% is probably five, maybe even $10,000.” (22:12)
• Out-of-pocket Maximum: Total you can be forced to pay in a year; after this, insurance pays 100%.

No Surprises Act (23:31–24:45)

• Protects against out-of-network “surprise” bills in in-network emergencies or when unable to choose providers.
  • “What the No Surprises Act does is it protects patients from out of network bills when they go to an in network hospital or in an emergency.” – Dr. Rosenthal (23:44)

Notable Quotes & Memorable Moments

• On Open Enrollment’s Difficulty
  • “It's a really, really important and really, really stressful time of year for people.” – Dr. Rosenthal (03:11)
• On Navigators/Brokers
  • “If you reach out to [navigators], ... they really know these sites like the back of their hands and can really help you.” – Dr. Rosenthal (05:27)
• On the Burden on Patients
  • “We shouldn't put so much responsibility on patients. I mean, it's so much detective work.” – Dr. Rosenthal (07:20)
• On Reading Your Mail During Open Enrollment
  • “If you see a health care thing on an envelope, you should open it to see what it says.” – Dr. Rosenthal (11:06)
• On Turning 26 & Insurance Gap
  • “It's not a happy birthday anymore.” (16:43)
• On Short-Term Plans
  • “They are more expensive. They do not comply with ACA basic standards.” – Dr. Rosenthal (13:32)
• On Out-of-Pocket Maximums
  • “Once you spent $20,000...your insurance has to cover the rest.” – Dr. Rosenthal (22:45)

Practical Takeaways

• Start Early: Don’t wait until the last minute—state marketplaces have deadlines, and help is harder to find late in the season.
• Confirm Your Network: Double-check every year that your preferred providers and facilities are still in-network.
• Use Navigators: Seek out help from certified navigators/assistors, not brokers working on commission.
• Scrutinize Plan Details: Compare deductibles, premiums, coinsurance, copays, and out-of-pocket maximums—not just the monthly cost.
• Open Your Mail: Read all insurance-related mail carefully for possible plan changes or discontinuations.

Timestamps for Key Topics

• [02:52]: What is open enrollment?
• [03:42]: Qualifying life events & COBRA
• [04:46]: Where to shop for insurance; Healthcare.gov vs. state marketplaces
• [05:23]: Navigators versus insurance brokers
• [06:47]: Confirming doctor/hospital in-network status
• [08:54]: Differences in state marketplaces; public options
• [10:51]: What happens if you miss open enrollment?
• [13:31]: Short-term health plans pitfalls
• [14:13]: Aging off a parent’s insurance plan at 26
• [17:03]: Glossary lightning round (HMO/PPO, HSA/FSA, deductible/premium, coinsurance, out-of-pocket max)
• [23:31]: No Surprises Act explanation

Conclusion

This practical, easy-to-follow episode prepares listeners to make smarter, more confident decisions during open enrollment. Dr. Gupta and Dr. Rosenthal stress the importance of vigilance, proactive research, and utilizing available expertise to navigate the complex world of health insurance in the US. “It’s worth the time,” Dr. Rosenthal concludes (25:09).