10 Things To Consider During Open Enrollment

Thank you Dignity Health for sponsoring this post. Enroll in humankindness. 

Choosing the right health insurance for your family can be hard.  Open Enrollment can be stressful, but here is some helpful advice to help guide you.  I am self-employed, so every year I reevaluate what insurance is best for my family.  Here are 10 things to consider during Open Enrollment. 

  1. Make sure your doctor is in the plan’s network– Unless you don’t mind changing doctors, you will want to double check to make sure your doctor is included in the plan you choose.  I LOVE my daughter’s pediatrician and when picking a plan my first priority is making sure he is in the plan’s network.  Californians don’t prioritize doctors when choosing health insurance. Even though a full 70% have a preferred doctor, clinic, or practice that they choose for healthcare, 47% go about Open Enrollment in the following order:
    • 1. Picking their insurance plan
    • 2. Selecting healthcare providers/doctors based on who is covered/in-network for that plan.  This is instead of working backward from their preferred provider and choosing the healthcare plan that he or she works with.  
  2. Understand plan and network types— HMO, PPO, POS, and EPO: Some plan types allow you to use almost any doctor or health care facility. Others limit your choices or charge you more if you use providers outside their network.  I have found that a PPO is best for my family, but I have a friend who swears by having a HMO. They each have advantages and disadvantages, so do a little research to help you choose which is best for you.
  3. Decide what are your top priorities in a plan ahead of time– Is it a PPO or HMO?  Is it a plan that has your doctor in network?  Lower monthly payments or lower deductible?  There is a lot to consider and you will want to prioritize what is most important to you and your family.  
  4. Start early–  Don’t want until the last day to try to decide what plan you want.  Start early and give yourself time to figure out what you want.  More than half of Californians, and nearly two-third of millennials, wish they spent more time on Open Enrollment. Nearly one-quarter (22%) of people spend less than an hour on making a decision on health insurance.
  5. Know the difference between a deductible and coinsurance– Your deductible is a fixed amount and ends, but coinsurance goes on and on (until you hit your out-of-pocket maximum).  Once you’ve met your deductible for the year, you don’t owe any more deductible payments until next year. You may still have to pay other types of cost-sharing like copayments or coinsurance though.  You will continue to owe coinsurance each time you get health care services. The only time coinsurance stops is when you reach your health insurance policy’s out-of-pocket maximum.  My daughter was born as a preemie.  I spent a week in the hospital and she spent 2 weeks in the NICU.  We learned very quickly all about deductibles, coinsurance, and out-of-pocket maximums that I didn’t ever think about before this.  
  6. Don’t stress– If you do your research and start early the stress should dissipate.  Half of Californians (50%) say selecting the best health insurance plan for them is extremely or somewhat stressful.  Help take away some of that stress by starting early.
  7. Don’t be afraid to call your doctor’s office– Call the office and ask if they have a preferred plan.  This can help guide you in the right direction.
  8. Make an informed decision– Do research about the plans you are deciding between.  After Open Enrollment ends 55% of Californians wish they had made a more informed decision.  
  9. Be familiar with “Metal Levels”– or metallic levels, refer to the bronze, silver, gold or platinum levels of coverage. Each level has a monthly premium vs. out-of-pocket cost. For instance, bronze plans have low premiums but high out-of-pocket costs whereas platinum plans have high premiums and low out-of-pocket costs.  
  10. Different plans can be better for different people–  Plans are not one-size-fits-all.  Just because your best friend says they have the best plan, that doesn’t mean it is the best plan FOR YOU.  Do some research on your own, follow these helpful tips and make an informed decision.  Maybe you find that a higher monthly payment is better for you because that means you have lower co-cayments or that a silver package is best suited for your family over a bronze package?  My family generally doesn’t have to visit a doctor more than once a year for a checkup, so higher copay on office visits is ok with me, but if you have to visit a doctor more often then selecting a plan with a lower copay would be beneficial.  Being educated on what my insurance plan covers gives me a great piece of mind, especially after the emergency and premature birth of my daughter.  You never know what life has in store for you, but you CAN know what your insurance covers.  Click here to learn more information about Open Enrollment and to help you make an informed decision.  

I hope these 10 things help take some of the stress out of Open Enrollment and help you make a more confident decision.  

I was selected for this opportunity as a member of CLEVER and the content and opinions expressed here are all my own.