Tips for choosing a health plan

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By COREY McCARTY

As we begin shopping for the holidays, it’s also important to remember that this is the time of year when individuals and Medicare recipients can enroll in or change health plans for the coming year.

All Rhode Islanders who signed up for health plans last year, whether through HealthsourceRI.com or an individual health insurance company, are required to re-enroll this year between November 15, 2014 and February 15, 2015. Medicare-eligible seniors were able to select or change their plan during the Medicare Annual Enrollment Period (AEP), which was open through December 7, 2014.

Like last year, there are a variety of ways you can buy health insurance if you don’t receive it through your employer. Understanding the options will help you select the plan that’s the best fit – whether you’re a senior choosing Medicare or a young adult shopping for the first time. While individual needs vary, here are some tips to help you choose the plan that will best meet your needs.

Choosing

and purchasing coverage

Just as you may have done in the past, you can purchase your health plan directly from an insurer. You can call them or visit their websites for information, or stop by their customer service centers or retail locations.

The state exchange, HealthSource RI, allows you to make side-by-side comparisons about health insurance options and receive tax credits if you are eligible. In addition to HealthSourceRI.com, you can visit their customer service center in Providence or call to speak with a representative over the phone.

If you are eligible for Medicare, you won’t go through HealthSourceRI. Instead, you can go directly to an insurance company for information online, in their retail locations, or at information sessions, or visit www.medicare.gov.

Make lists: healthcare needs, medications and doctors/pharmacies

As you look at different health plans, be sure to take into account the following basic information:

Healthcare needs: What healthcare services do you use regularly? How often do you see your primary care physician and specialists? Do you anticipate any special needs next year, like surgeries? Make sure these services are covered and compare out-of-pocket costs like copayments, coinsurance and deductibles.

Medications: Check each health plan’s prescription drug list (also known as a formulary) to make sure your current prescriptions are covered, and compare out-of-pocket costs. This is a great time to ask to talk to your doctors about generic versions of drugs that may work equally well but cost less.

Doctors and pharmacies: Use this list to make sure your doctors participate in the networks of plans under consideration.

Other considerations as you weigh your options:

Out-of-network benefits make sense for travelers. If you will be traveling or spend part of your year away from your primary residence, make sure the plans you’re considering include coverage outside of your network. Some plans also cover emergency care outside the U.S.

Co-payments and deductible charges. With your anticipated medical expenses in mind, look carefully at the premiums, co-payments and deductible charges offered by each plan. If you’re looking for a Medicare plan and don’t anticipate many medical expenses, you may benefit from a plan with a low premium or no premium at all (also called $0 premium plans). These plans often have higher out-of-pocket expenses than plans with premiums, but may be more cost-effective for people who don’t use many services.

Preventive and wellness services. More preventive services, including mammograms, colonoscopies and “well” visits, are now covered by insurance without coinsurance or deductible charges. Some plans offer additional covered benefits like $0 co-pays for generic drugs, $0 co-pays for doctor visits within coordinated care networks (also known as patient centered medical homes), low-cost fitness programs and allowances for vision and hearing hardware.

Above all else, take your time choosing a plan and make sure to weigh all of your options. With these tips in mind, you will be well on your way to choosing the health plan that will be the best fit for your individual needs.

Corey McCarty is the vice president, consumer segment, for Blue Cross & Blue Shield of Rhode Island.)

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