What You Need to Know About Health Plans

Health plans come in a variety of designs and can vary in the health care services they cover. The process of knowing when to enroll, choosing a health plan and understanding its details can be overwhelming. The following tips may help you better understand your options.

When to Enroll
There’s only a certain time each year when you can sign-up or change your existing health coverage. It’s called the “Open Enrollment Period” or “Annual Enrollment Period.”  This typically occurs during the fall months, but it can vary based on your employer.

Of course, life happens, and you may need to sign up or change your insurance coverage outside of the “Open Enrollment Period.” Events such as switching jobs, getting married or having a baby may qualify you for a special enrollment period.  For more information, you can learn more about what else counts as Qualifying Life Events.


What Health Plan to Choose
Many people pick a health plan based on the monthly cost (the premium) and overlook the plan’s coverage and additional expenses, such as a deductible, throughout the year. Take some time to read through your options, so you can choose the right plan for you. Some questions you may want to consider include:

  1. How often do you receive care? If you are young, healthy and rarely see a doctor, you may want to select a plan that has a lower monthly cost (premium) but requires you to pay more out of your pocket when you need care. If you need frequent care or visit your doctor often, a plan with a higher monthly cost and lower fees per visit might be more affordable over the course of the plan year.

  2. What is the network like? Health plans manage costs by having a specific “network” of providers, clinics and hospitals care for their members. If you prefer a particular doctor or facility, it’s important to make sure those health care providers are “in network.” If they’re not, you’ll likely end up paying more –and in some cases a lot more – to visit them. 

  3. Do you take prescriptions?  If you take prescription drugs, check the cost of those medications, because they may vary widely based on the insurance plan. This may be important to you in helping manage health care costs. 

  4. Do you want access to ancillary benefits, wellness or incentive programs? “Ancillary benefits,” like dental, vision, accident, disability or critical illness plans, are often affordable options that can help provide additional protection for you and your family. If your plan doesn’t include these benefits automatically, you may be able to add them at minimal cost. In addition, some health plans offer perks beyond visits to doctors and hospitals, such as wellness programs that may help you lower your cholesterol, quit smoking or lose weight. Incentive programs may also be offered like discounted gym memberships or wearable fitness trackers to help you reach your health goals.


How to Understand Your Health Plan
The first place to start is to review the Summary of Benefits and Coverage (SBC). By law, all health plans must share this document with plan members. It will indicate which doctors or health care facilities are “in network,” which services or medications are covered and the percentage of cost the health plan will pay for a service or medication.

For example, the SBC will list any out-of-pocket costs, such as copays or co-insurance you may owe when visiting your doctor or an emergency room. It will explain how much your plan will pay if you need surgery or a hospital stay, and whether it covers services like dental and eye care.

You may get this information in the mail or you may need to view it online. Some health plans have also created apps and web-based resources that can help you manage your care, such as finding a doctor or comparing costs of services. Reviewing and understanding your health plan and its benefits can help you make more informed choices about your care.

If you have questions, you can call your health plan for help. Just use the contact information in your plan documents or on your insurance ID card. For more help understanding your benefits, learn about Getting the Most of Your Plan Benefits.