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October 19, 2010 > Five tips for choosing your health plan during open enrollment

Five tips for choosing your health plan during open enrollment

By Christine Paige

Choosing health-insurance coverage is one of the most important health care decisions Americans make-and for millions of Americans with employer-based coverage, that decision is made around this time every year, during open-enrollment season.

What should be a thoughtful decision, though, is often made in matter of minutes-and that's a mistake. Employees need to carefully evaluate their options when considering health care coverage for themselves and their families, and they should consider these five important steps before making their decision:

1) Review your past health care experiences;
2) Estimate your health care needs for the coming year;
3) Consider what you want from your physicians and health care providers;
4) Determine which online support tools are important to you;
5) Examine all costs involved in maintaining your health-and the plan's total value.

First, thoroughly review your past health care experiences. Assess your current health plan's overall value to you and your family. What do you like - and what do you want to change? Are you happy with the level of service and support you receive? In California, we have easy access to independent, online comparisons of health plans' quality and service. The State of California Office of the Patient Advocate (www.opa.ca.gov) offers ratings of plans based on the quality of care members receive and what members say about their care.

Next, assess your health-care needs for coming year. What has changed for you in the past year, and what changes are coming next year? For example, maybe you've developed a chronic condition that will require more doctor visits or prescriptions. Or maybe you plan to have a baby. Review your options based on how you live your life.

Next, evaluate a plan's care delivery system or network based on your specific needs. Do you want the option of going to a large network of doctors, specialists and hospitals? Do you prefer a PPO? Or do you prefer a health system with a strong emphasis on prevention and where care is coordinated among physicians?

You should also understand the full extent of what a plan offers in terms of online tools. Consumers have more demands on their time, and they want easier and faster access to information so they can manage their health at their convenience.

Finally, consider all your health-care costs and services before selecting your plan. Don't automatically sign up for the plan with the lowest premium. Look at the total value you are getting in terms of services and costs. How much did you spend on health care in the past year - including premiums, deductibles, co-pays for physicians, hospital stays and prescriptions? And what did you get for it?

Then, look at your options for the coming year. For example, what services does the plan provide, and what are the plan's co-pays for office visits, hospital visits and prescription drugs? What is the deductible? Once you know the answers to these types of questions, you'll be prepared to choose the health plan that's right for you.

It takes time to be an informed health-care consumer, but it's time well spent.



Christine Paige is a senior vice president for Kaiser Permanente.

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