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. To view a list of insurance carriers contracted with Providence, call 1-888-HEALING (432-5464) or visit california.providence.org. From the top navigation, select “Find a Doctor” and then click “Accepted Insurances.”