By Guest commentary Thursday, October 5th, 2023

By Dr. Sabrina Brana 

Whether you’re covered through your employer’s health insurance, have opted for a Covered California plan, or are preparing to change your health coverage, it’s important to carefully assess your open enrollment needs.

Choosing a health plan doesn’t have to be intimidating. In fact, it’s an opportunity to ensure you are getting the best coverage to meet your (and your family’s) health care needs. Think of it as an annual checkup for your healthcare plan. 

As a physician, I’m used to answering questions from patients related to their coverage. Knowing the questions to consider when selecting a pan, can help demystify the process and provide you with tools to choose a plan for 2024 that’s best for you.

First, consider if you or your family expect to experience any “life changes” in the upcoming year. This includes pregnancy, anticipated or elective surgeries and other significant health events that may significantly impact your care needs. Consider your need for doctor visits, prescribed medication and laboratory services. Look for a plan that provides the best access to local resources you anticipate using at the best coverage levels.

Take a moment to reflect on your health over the past three years. Is your current plan still meeting your needs? Do you need more coverage for office visits or certain prescription medications? Go through your receipts and compare your current out-of-pocket costs, deductibles, copays and benefits with what would be available to you with different plan options. Sometimes a plan with a slightly higher premium may offer better coverage and end up more affordable by the time all costs are factored in. 

Check to see if your preferred primary and specialty care physicians are “in-network” with any given health plan you’re considering. Staying with the doctors you trust is important for continuity of care and allows you to maintain the relationships you’ve built over time with your health care team. Some plans also cover a portion of office visits with providers who are “out-of-network,” so if you’ve established care with a specialist you only see on occasion, it may be worth it for you to stick with them.

I also recommend making a list of your medications to compare to the covered medications (called the “formulary”) for the plans you are considering. The cost of prescriptions can vary significantly between plans and if you predict you’ll be on a certain medication (or class of drugs), it’s best to find a plan that covers your needs.

Common Open Enrollment Resources

During Open Enrollment, you have access to several valuable resources:

• Employer guidance: Your employer will provide information about the health insurance options they offer, including costs that may be associated with certain types of coverage.
• Insurance plan representatives: Reach out to insurance plan representatives who can help you compare plan features to evaluate which plan best fits your needs.
• Your physician: Your current physician is a trusted resource who understands you and your family’s health care needs. They can provide insights into the referral network and help you make informed decisions.
• Insurance provider: Your insurance provider is the ultimate resource for confirming what is covered, which providers are in-network, and understanding your coinsurance and copay for specific services.
• Covered California: Covered California is the state’s marketplace that is open to anyone purchasing insurance. Open Enrollment is November 1-January 31. If you plan to purchase a policy here, it’s important to mark these dates on your calendar and take action during this window to make any necessary changes to your plan.

Open Enrollment is an opportunity to take control of your health care and build a plan that works for you. By carefully considering your family’s needs, keeping your trusted doctors in your network, and researching by utilizing available resources, you can navigate this season with confidence and make informed decisions that benefit your health, wellbeing and wallet. 

Dr. Sabrina Brana is an Internal Medicine Specialist at Dignity Health Medical Group in Ventura County and she is currently accepting patients. Learn more about Open Enrollment at: dhmf.org/Ventura.