Choosing the right health plan during Open Enrollment - PIH Health

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Published on October 21, 2014

Choosing the right health plan during Open Enrollment

Choosing the Right Health Plan

Choosing the Right Healthcare Plan

Every year between October and December, the majority of Americans will receive letters or packets from their employers’ human resource departments or Centers for Medicare and Medicaid Services (CMS) explaining their health coverage options for the following year. Some people may also receive information about the Affordable Care Act health insurance marketplace, also called Covered California. 

Here are four things to consider as you decide the type of coverage that is right for you.

Review last year’s bills

If you did not go to your doctor very often or did not have too many prescriptions, you may want to pick a plan with less expensive premiums. Take a closer look at the deductibles, the premium and the maximum out-of-pocket costs of the plan and compare them to the previous year. You may find the deductible is higher, but if you only visit your family doctor once or twice a year, it will likely be less expensive overall.

Plan with your family

Most insurance benefits change year over year. Commercial group and individual plans may only change slightly, but Medicare Advantage plans can change quite drastically. The plan you have this year may not cover the same benefits or at the same level as you need.  For example, the number of days covered for hospitalization may not be sufficient for an upcoming surgery.

Many seniors are used to the plan they currently have, but their healthcare needs may have changed over the course of a year. Involve your spouse and your children while choosing a Medicare Advantage plan to help identify the option that best meets your needs.  

Know your options and physicians 

There are often two types of plans: Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). The monthly premium for an HMO may be lower than a PPO, however your choice of specialty doctors and hospitals are limited to that plan’s network and your care will be coordinated through a Primary Care Physicians (PCP).  Also, by contrast, a PPO gives you access to a larger provider network and the option to go out of network with higher copays, but you will be responsible for coordinating and managing your care. 

An Explanation of Benefits (EOB) will be included in your health plan packet, and it will list the services that are covered. You can also find an EOB in your company’s benefits program booklet so you can compare the various plans.

As the benefits change every year, many medical groups and hospitals provide benefit comparisons of their accepted health plans before open enrollment begins. It’s a good opportunity for you to review and compare options before picking the plan that best fits your needs and allows you to stay with the physician network affiliated with your preferred hospital.

Ask the experts

Talk to the benefits specialist in your HR department or a trusted health insurance advisor who can present and explain the details. This is your health insurance for the upcoming year. You’re paying for it, so don’t be afraid to ask questions.

Health plans and medical groups usually have their own sales representatives or brokers. Your doctors may also have trustworthy brokers they can recommend.

For more information, call PIH Health’s Patient Services line at 888.365.4450.

The information in Healthy Living Online is for educational purposes only.  It is not intended nor implied to be a substitute for professional medical advice.  The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation, or if they have any questions regarding a medical condition or treatment plan.

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