Navigating open enrollment? Here’s what to consider
Whether you get your health insurance through an employer or through the health insurance marketplace, open enrollment is in full swing. Comparing insurance plans and trying to figure out which option is best for you may feel like a chore, but it’s easier if you understand the essentials.
Kristen Kendrick, DO, an osteopathic family medicine physician in Washington, DC, and AOA human resources analyst Amy M. Stark explain what’s important to keep in mind when choosing a health insurance plan.
Know your priorities
When comparing health insurance options, human resources analyst Amy M. Stark advises considering the following:
- Premium cost: What is the monthly cost of the insurance plan?
- Deductible: How much will you need to spend out-of-pocket before your insurance kicks in? Keep in mind that plans with low monthly premiums often have high deductibles; it’s wise to pay close attention to both of these factors for each plan you’re considering.
- Physician network: Look up any physicians who are already treating you—are they in-network or out-of-network with the plan you are considering?
- Prescription coverage: What prescription coverage does this plan offer?
- Pharmacies: Which pharmacies are considered in-network and which are out-of-network?
- Hospitals: If you anticipate any major medical events or procedures in the coming year, this question is especially important: which hospitals are designated as in-network vs. out-of-network in your possible plan?
Prioritizing these factors will depend on your own health and financial situation, as well as the health of any family members who will also be covered on the plan. While the monthly cost of the plan is typically the biggest concern, it’s also a good idea to make sure the plan you’re considering will allow you to continue seeing your existing physicians in-network.
For individuals with a more complex health situation, the priority list might look a bit different.
“If you have a chronic condition that involves medications and frequent physician appointments, it’s important to focus not only on monthly premium costs, but also on out-of-pocket costs,” Dr. Kendrick explains. In that situation, it might make sense to prioritize a plan that offers a lower deductible.
Consider finding a DO
Open enrollment is a great time to research new physicians—and, potentially, find a DO in your area who is part of the insurance plan you’re considering. Osteopathic physicians, or DOs, are fully licensed physicians who receive additional training about the musculoskeletal system. They are equivalent to MDs and can practice in any specialty, including primary care, but are trained to take a holistic approach to health and healing.
For Dr. Kendrick, caring for patients who have headaches or migraines is a prime example of the “osteopathic approach” in action. “As a DO, I think it’s important to look at the multitude of reasons why someone might be having a headache, vs. jumping to prescribing medication right away,” she explains. “I might ask about the person’s nutrition, their lifestyle, and things that could be causing musculoskeletal issues, such as how they sleep, how they sit at a computer, or how they drive.”
After becoming familiar with the patient’s situation, Dr. Kendrick says, she might refer them for osteopathic manipulative treatment or physical therapy to address the underlying issue that’s causing the headache.
Advocate for yourself if needed
What if your open enrollment research reveals that your longtime physician will no longer be in-network with your insurance plan?
Dr. Kendrick understands that fear. “When open enrollment comes around, I think everyone’s worried that something will change and they’ll have to switch to another doctor,” she says. “I encourage people to advocate for themselves to see what could be done—don’t just give up if you want to stick with your doctor.”
You could try speaking with your physician directly, or, if your insurance is through your employer, ask your employer whether your physician could remain in-network for the coming year. If nothing else, Dr. Kendrick says, having these conversations may help you find out what the cost might be if you decided to continue seeing your physician on an out-of-network basis.
Look for a physician who’s a good fit
When choosing a primary care physician, Dr. Kendrick says, it’s important to focus not only on medical acumen but also on the rapport between you and your physician. “It’s important that your doctor is someone you feel you can be honest with,” she explains. “We see a lot of patients who are scared to ask questions or anxious to tell you the whole story. You want a physician you can tell everything to—someone whose personality kind of meshes with yours and you feel you can trust.”