 Open enrollment season is upon us once again, which means many of us will be facing the challenge of choosing a new health plan. It’s no secret that price is often the driving factor for health care consumers when selecting a plan. In a test conducted by Blue Cross Blue Shield of Rhode Island in 2012, 48 percent of consumers listed the monthly premiums that they would be responsible for as the most important factor when picking a plan.
While there’s no doubt that cost has to be consideration, other factors should also come into play. Before you even examine a plan’s costs and summary of benefits, you should sit down with your primary care physician and review your medical issues. Ask your doctor about your active medical problems. Are there any potential procedures or surgery that may be required in the next year? Do you require certain prescriptions on a regular basis? If a plan doesn’t cover certain medicines or treatments, your out-of-pocket costs will likely be higher. If you’re unsure about whether a treatment is covered, check the company’s website or call their support line. The key is to gather as much information as possible before making a decision.
You’ll also want to determine if your physician or physicians are included in the plan’s network. Network lists can be outdated and an increasing number of doctors are opting out of networks. Cheaper plans often have limited provider/physician networks, which means you’ll save money on premiums but may not have access to the doctors you want to see. Long-term success in your treatment is more important than short-term costs. Again, don’t be afraid to call your doctor to find out if he or she is included in a plan you’re considering.
Once you’ve done your research and you’re aware of your medical needs and which networks include your providers, cost concerns should be addressed. If you choose lower deductibles you’ll likely be paying higher premiums. The converse is also true with lower premiums often coming at the cost of higher deductibles. If you expect your utilization of health care to be high, then opting for a lower deductible plan might make more sense because you’ll have a better chance of limiting out-of-pocket costs. If you anticipate low utilization, then a higher deductible plan could be the right choice because you won’t end up paying high premiums for services you won’t use.
At the end of the day, keep in mind that you get what you pay for. You can’t get the best doctors, state of the art technology and top quality care in a timely fashion for low cost.
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