Guest commentary: Don’t rush open enrollment
By Dr. Micah Dickey
Are you spending 30 minutes or less choosing your healthcare plan? You might be missing out on significant savings and better coverage.
Although the annual selection of a healthcare plan may seem daunting, it is imperative to reassess your coverage each year rather than automatically renewing your existing plan.
Whether you receive healthcare through your employer, a Covered California plan, or are preparing for a change in health coverage, selecting the right plan to meet your needs ensures you’ll have an easier time at doctor’s appointments, picking up prescribed medication, and even during an unexpected hospital stay.
As a physician, I hear a lot from my patients during this time related to their coverage.
Knowing the questions and other factors to consider when selecting a plan is the key to navigating the open enrollment process with ease.
There are four things I tell patients to consider during Open Enrollment.
CALCULATE THE COSTS
Before choosing your 2025 benefits, take a few minutes to reflect on your and your family’s health over the past three years.
Has your current plan been meeting your needs or would it be beneficial to have more coverage for things like office visits or prescription medication?
Get out some pen and paper and add up the costs.
Then compare your out-of-pocket expenses, deductibles, copays and benefits and how those might change with a different plan.
For example, if your out-of-pocket expenses last year totaled $1,500, and a different plan with a lower deductible and copay could reduce that to $1,000, that’s a $500 savings.
ASSESS POTENTIAL LIFE CHANGES
Next, you should consider if you or your family expect to experience any life changes in 2025 — like a pregnancy, anticipated or elective surgeries, a new treatment regimen, or other significant health events that could impact your care needs.
Consider your need for doctor visits (primary care, preventative and specialists), prescribed medication and laboratory services.
Look for a plan that will provide access to all the resources you might need at the best coverage levels and cost structure for you.
CONSIDER CONTINUITY OF CARE
Third, staying with doctors you trust is important for continuity of care and allows you to maintain comfort and trust through the relationships you’ve built with your health care team.
When choosing a plan, double-check that your preferred primary and specialty care physicians are still “in-network” with any of the plans you’re considering.
It’s important to review this every year because relationships between health networks and insurers can change.
Also, some plans may 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 once or twice a year, it may be worth it for you to stick with them.
REVIEW MEDICATIONS
Finally, make a list of your current medications and compare it to the plan’s covered medications — called the “formulary” — for the plans you’re considering.
Prescription costs can vary between plans and it’s best to try to find one that will cover your needs.
OTHER HELPFUL RESOURCES
During Open Enrollment season, you’ll likely have access to several valuable resources that assist in choosing the right healthcare plan that meets your needs.
I encourage you to take advantage of any of the following, including:
• Employer guidance: Your employer will provide information about the insurance plans they offer, including costs that may be associated with certain types of coverage.
• Your physician: Your current physician is a trusted resource who understands you and your family’s healthcare needs. They can provide insights into the referral network and help you make informed decisions.
• Insurance plan representatives: Reach out to insurance plan representatives who can help you compare plan features and answer any specific questions you might have that will help you determine which plan best fits your needs.
• 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 for Covered California is November 1, 2024-January 31, 2025. If you plan to purchase a policy through the marketplace, it’s important to mark these dates in your calendar and take action to make any necessary changes to your plan.
Open Enrollment season is an opportunity to give your health plan a check-up of its own.
Make a plan to do your research, talk to your providers and ensure you have everything you need to confidently build a plan that works for you and your family in 2025.
Dr. Micah Dickey is a part of Dignity Health Medical Group – Ventura County, which is currently accepting patients. Learn more about Open Enrollment at dhmf.org/Ventura.
