Keep an Open Mind: Annual Open Enrollment is Your Chance to Choose the Right Health Plan

October 01, 2013

For many employer-offered insurance plans, open enrollment soon will be in full swing. But if open enrollment feels more like open season—with its annual onslaught of insurance gobbledygook that’s too difficult to decipher—here’s a quick guide on how to choose the right health plan for you.

The Key Questions

Open enrollment involves more than simply picking the same benefits plan you had last year. Plans change, costs rise and your own health needs shift over time. It’s important to consider these variables—in addition to ensuring that your Providence-affiliated physicians are still contracted with the plan you choose. To begin, ask yourself a few simple but important questions.

What will it cost? Plans with lower premiums—the amount that comes out of your paycheck—usually require higher out-of-pocket expenses. “If you are young and not sick very often, you might pick a plan with a lower premium,” says Rich Snader, regional director of managed care, Providence Health & Services, Southern California.

However, if you have been recently diagnosed with a medical condition or you plan to start a family, a higher-premium plan with lower deductibles and coinsurance might be for you.

What will it cover? If your health needs are changing, scour your open enrollment package for the benefits you’ll need. If you have questions, attend your company’s benefit plan meetings.

If you take prescription drugs, check out each plan’s drug formulary. “Find out if your prescriptions are covered and at what level,” advises Karen Carrol-Kowalski, director of marketing and customer service for Facey Medical Foundation, the operational side of Providence-affiliated Facey Medical Group.

And remember, the Affordable Care Act now allows parents to keep adult children on their health plans until age 26.

Who can I see? Is your doctor or preferred hospital on your plan? “As a Providence consumer, when I choose an HMO or PPO, I want to make sure I have Providence as an option,” Snader says, noting that his team in managed care ensures Providence providers are contracted with as many health plans as possible.

Why Choose Providence?

As the Affordable Care Act takes effect, it’s important to align with physicians and health systems that understand its complexities.

“Coordinated care is where health reform is going,” says Dale Surowitz, regional chief operating officer for Providence Health & Services, Southern California. Providence offers outstanding care with an electronic medical record system that ensures coordination throughout the system.

Surowitz also notes that when you’re connected to Providence, you’re connected to the expertise, advanced technology and specialty services that extend from San Pedro to Santa Clarita. “We offer choice in terms of facilities that are conveniently located and choice in terms of a 3,200-physician medical staff that provides options for consumers,” he says.

New with Medicare

Medicare open enrollment, from Oct. 15 through Dec. 7, is when Medicare beneficiaries select or change their health insurance plans.

To get started, visit Medicare.gov and search “Find health & drug plans.” You’ll enter your ZIP code and current prescriptions, and then refine your search by the criteria that matter most to you. For example, you can search by plan ratings, drug options and deductibles.

Carrol-Kowalski advises Medicare patients to pay attention to new changes. New this year, Medicare recipients can select from “special needs plans,” which offer coverage for diabetes and heart conditions. “Someone who has a diagnosis of diabetes or heart disease should ask their insurer, ‘Do you have a special plan for someone like me?’ as opposed to going on a straight HMO plan that might not offer needed benefits,” she says.

Secondly, scrutinize your plan options carefully for copay hikes or benefit cuts. “It’s possible benefits may change for 2014. For many years plans have been able to offer some benefits with a zero-dollar copay, but we may see small copays applied as Medicare will be lowering payments to insurance companies,” she says.

In the end, whether you’re signing up for an employer benefits plan or Medicare, it pays to do your homework.

“Look at all your options,” Carrol-Kowalski advises. “Don’t assume that the plan you’ve always had is still the right plan for you.”