š Updated for 2026 — enrollment deadlines, ACA income thresholds, and COBRA rules verified current as of last review š Reading time: 17 minutes | ✍️ ExpatWiki Editorial Team T he email arrived on a Wednesday in late October. Open enrollment closes Friday. Three plan options, a 47-page benefits guide attached, and a decision that would govern every doctor's visit, prescription, and hospital stay for the next twelve months. A data scientist from Hyderabad, six weeks into her first H-1B job in Chicago, stared at terms she'd never encountered — deductible, out-of-pocket maximum, in-network, coinsurance — and picked the plan with the lowest monthly premium because the number was the only one she understood. She spent $4,200 out of pocket that year. The plan next to it: $800. Same employer. Same year. Health insurance open enrollment in the US is a high-stakes annual decision made under time pressure, using terminology most new arrivals have never encountered, for a ...