There is a lot to consider when choosing a health benefits plan. Selecting a plan that’s right for you and your family is a big decision. Ask yourself these questions to determine which health benefits plan will work best for you:
• Are you eligible for the health plan based on where you live? Health plans can differ by residency requirements, so it’s important to select a plan that you’re eligible for based on where you live.
• Are your current doctors included in the health plan’s network? If you currently have a preferred primary care doctor, for example, it’s important to check that your doctor is included in your potential health plan’s network so you can continue seeing that provider.
• Are you comfortable electing a primary care doctor? Some health plans require you to choose a primary care doctor, so if you don’t feel comfortable selecting one, you may prefer a plan that doesn’t require one.
• Do you mind seeking referrals from your primary care doctor for specialist visits?
Some plans require referrals from primary care doctors for specialty services and some plans do not require referrals. Be sure to check your potential plan’s requirements before selecting.
• Do you travel often? Your health plan may or may not offer coverage when you travel nationally or out of the country, so it’s critical to check your potential plan’s travel coverage.
• Do you have out-of-state dependents? Certain health plans will provide coverage for children, students and/or dependents who need care in other states. Check that your plan will cover these dependents if that’s necessary for your family.
• Does the health plan offer virtual care options?
Virtual care allows you to see providers on your own time, in the comfort of your home. If that’s an option that’s important to you, be sure your potential plan offers virtual care coverage.
• Are the prescription drugs you regularly use covered by the plan? It’s important to check that your prescription medications will be covered and what the potential cost will be before selecting a plan.
It’s also a good idea to compare networks, premiums, and out-of-pocket costs. Before selecting a health plan, be sure to check the following information:
• Networks: You’ll get more out of your insurance plan and save money by selecting doctors in your plan’s network. If you choose to see an out-of-network doctor, your visit costs may not be covered.
• Premium: What you pay monthly for your health plan. Typically, the more coverage you have, the more you pay in premiums.
• Deductible: What you pay for care before the plan pays. The larger the deductible, the less you pay in premiums for a health insurance plan.
• Copay: What you pay when you visit a healthcare provider.Copays are fixed amounts and can vary for different medical services or providers.
• Coinsurance: The percentage of costs you pay after you meet your deductible. Your coinsurance percentage will vary depending on the health insurance plan you choose.
• Out-of-pocket costs: Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services. Out-of-pocket costs are usually more when you see an out-of-network doctor.
• Maximum out-of-pocket limits: The most you will pay annually for coverage. If you meet that limit, your health insurance plan will pay 100% of all covered healthcare costs for the rest of the plan year.
Annual Enrollment for Group Insurance Commission members runs from April 2 – May 1, 2025. It’s the perfect time to review your health benefits plan to ensure you have coverage that meets your needs and budget. Learn more about Wellpoint health plans at wellpointmass.com.
