Open enrollment closes, the elections come back, and most employers never learn whether their people chose well. Payroll deductions start, and the questions only surface later: when an employee gets a bill they did not expect, or finds out the doctor they wanted to keep was in the lower-cost plan all along.
Enrollment education usually gets budgeted as a cost of running benefits. It is better understood as an investment. The money an employer puts into a health plan only pays off when employees pick the plan that fits them, and most employees are picking with very little help.
Related: how we help employers improve workforce health and control healthcare costs all year, not just at renewal.
Most Employees Choose in Under Half an Hour
In an Aflac survey of U.S. workers, 93% said they choose the same benefits every year, 56% spend less than 30 minutes researching their options, and only 35% said they fully understand what their policy covers. Forty-three percent described enrollment as stressful.
That is a large decision to make quickly. According to the KFF 2025 Employer Health Benefits Survey, the average family premium for employer coverage reached $26,993, with workers paying $6,850 of it. Forty-six percent of covered workers are enrolled in a PPO, compared with 12% in an HMO.
What a Wrong Pick Costs
The best-known study of this problem, “Choose to Lose” in the Quarterly Journal of Economics, followed 23,894 employees at one large U.S. employer who were offered a menu of plans. A majority chose plans that cost them more than another option on the same menu no matter how much care they ended up using. The excess spending equaled 24% of the premiums for the plans they picked.
Lower-income employees were more likely to make those choices, and most did not switch the following year. The researchers traced the problem to a lack of understanding of how health insurance works, not to a preference for the costlier plan. Nobody picks the wrong plan on purpose. They pick it because nobody walked them through the math.
Who Are Your Employees Asking?
When an employee has a question about the plans, it usually goes to one of five places:
- A coworker, who chose for a different family, a different budget and different doctors.
- A spouse, who may be comparing against another employer’s plans with different rules.
- HR, whose team knows the plans but should not have to hear an employee’s medical history to answer the question.
- The carrier’s customer service line, which answers coverage questions but is not there to recommend one plan over another.
- Last year’s election, which is what most employees end up following.
Employee Benefit News recently described the same pattern: employees default to the carrier and plan they already know, even when another option on the menu would serve them better. Small details in a benefits guide, such as how coinsurance works, which tier a prescription sits in or which network a doctor belongs to, can decide whether a plan costs an employee more or saves them money.
Does the Employee Need a PPO, or Just Want One?
This is the question we hear most. A PPO feels safer, and for some families it is the right plan. For many others it is a larger payroll deduction for flexibility they never use. (For how the plan types differ on paper, see our comparison of HMO, PPO and EPO plans.)
The most common reason employees give for choosing a PPO is keeping their doctor. Very often that doctor participates in both the carrier’s HMO and its PPO. Checking the HMO directory for every doctor, specialist and hospital the family uses takes a few minutes, and it is the most useful thing an employee can do before enrolling.
When a PPO Earns Its Cost
- A dependent lives outside the HMO’s service area, such as a college student or a spouse working in another state. Some HMOs offer limited away-from-home coverage, so check the plan’s rules first.
- A family member sees a specialist or uses a hospital that is in the PPO network but not the HMO.
- Someone in the family needs ongoing care from an out-of-network provider, and the PPO pays part of it.
- The employee spends long stretches outside the service area and needs routine care there.
- The employee wants to see specialists without a referral and the HMO requires one. That is a preference, and some employees will reasonably pay for it.
When an HMO or Another Option Usually Fits
- Every doctor the family uses is in the HMO network.
- The family lives in the service area year-round.
- The main worry is emergencies while traveling. Emergency care is covered on an HMO at in-network cost sharing, so a PPO is not needed for that reason alone. Follow-up care after the emergency is where networks matter.
- The employee uses little care and could put the premium difference toward a health savings account, in which case a high-deductible plan with an HSA may be the better fit.
Wanting a PPO is a fine reason to buy one. It should be a choice the employee makes knowing the price, not a default they fall into.
How to Tell Whether Your Enrollment Is Working
An employer cannot see individual medical decisions, and should not. The pattern of elections still says a lot. These are signs your employees need more help choosing:
- Nearly everyone lands in the richest plan, regardless of age, salary or family size.
- Elections barely move from year to year, even after plan designs or contributions change.
- HR fields the same plan-comparison questions every enrollment and cannot answer them without hearing personal details.
- Employees are surprised mid-year by deductibles, referral requirements or out-of-network bills.
- Few employees in the high-deductible plan open or fund the HSA that goes with it.
- Employees call their benefits expensive but cannot say what their plan covers.
What Investing in Education Looks Like
Our clients handle this in a simple way: they tell their employees to call us. When an employee wants help deciding which plan fits, that conversation happens with a licensed insurance broker on our team, not with HR. On the call we:
- Look up the employee’s doctors, specialists and hospitals in every network on the menu.
- Ask about the care the family expects this year, such as a new baby, a planned surgery, ongoing prescriptions or a child leaving for college.
- Compare the total yearly cost of each plan, meaning payroll contributions plus expected deductibles, copays and coinsurance, not the premium alone.
- Explain how referrals, networks and prescription tiers work on each plan.
- Help the employee decide whether a PPO is a need or a want, and what it costs them either way.
The employee makes the choice. Our job is to make sure it is an informed one. Employees can talk through things with us they would not want to raise with their manager, and HR gets its enrollment weeks back.
Around those calls we support the rest of benefits enrollment: on-site enrollment meetings, plain-language benefits guides, online enrollment with a built-in decision help tool, licensed benefit counselors including Spanish-speaking counselors, and a 24/7 chat assistant for simple questions after hours. Our employee benefits concierge stays available after enrollment for claims and billing questions. We work in service teams of five, so the people answering your employees’ questions during enrollment are the same people who built your renewal with you.
If you are planning your next enrollment now, our open enrollment guide covers the calendar and communications side of the process.
Questions We Get
Can HR recommend a health plan to an employee?
HR can explain the plans, the payroll contributions and how enrollment works. Recommending a specific plan is different. It usually means knowing an employee’s medical needs and finances, which many employees would rather not share at work, and it is the kind of guidance a licensed insurance broker is trained to give. Pointing employees to your broker keeps HR out of that position.
Is a PPO always better than an HMO?
No. A PPO offers broader access, including some coverage outside the network, and it usually costs more in payroll contributions. If every provider a family uses is in the HMO network and the family lives in the service area, the HMO often delivers the same care for less. The PPO earns its cost when a dependent lives out of the area, a needed provider is only in the PPO network, or the family expects ongoing out-of-network care.
How can an employee tell whether their doctor takes the HMO?
Search the carrier’s provider directory for the specific HMO network named in your plan, not the carrier as a whole, and confirm with the doctor’s office before enrolling. Many doctors participate in both a carrier’s HMO and its PPO. Our team can run that check for the employee as part of the call.
When should employees call CFH?
Any time before their enrollment window closes, and again after a life event such as marriage, a birth or a move, which opens a special enrollment window. The earlier the call, the more time there is to check doctors, prescriptions and costs.
How do we know whether our employees chose the right plans?
Look at the pattern of elections rather than individual choices. If nearly everyone lands in the richest plan regardless of age or family size, elections never move after plan changes, HR hears the same comparison questions every year, or employees are surprised by bills mid-year, your employees need more help choosing than they are getting.
Sources: KFF, 2025 Employer Health Benefits Survey; Bhargava, Loewenstein and Sydnor, “Choose to Lose,” Quarterly Journal of Economics, 2017; Aflac WorkForces Report, 2019; Employee Benefit News, 2026.
General information about choosing a health plan, not advice for any individual situation. Networks, costs and plan rules vary by carrier and by employer.
Are your employees choosing plans on their own? Switch to CFH. Give them someone to call.
