Open Enrollment Checklist: How to Choose a Health Plan That Works for Your Care

Health insurance open enrollment in Wisconsin is an opportunity to look beyond the monthly premium and make sure the plan you choose actually works for the healthcare you expect to need.

Health insurance can be confusing. During Open Enrollment, you're comparing premiums, deductibles, networks, copays, prescription coverage, and benefits—often across plans that look remarkably similar at first glance.

It's tempting to focus on one question: Which plan costs the least each month?

But your premium is only one piece of what you'll actually spend on healthcare. Just as important is whether your doctors are in-network, what you'll pay when you need care, how prescriptions are covered, and whether you'll have reasonable access to the specialists and services you may need.

Before you enroll, here are some of the most important things to consider.

Look Beyond the Monthly Premium

The premium is the amount you pay each month to maintain your health insurance coverage. A lower premium can certainly be attractive, but it doesn't necessarily mean the plan will cost you less over the course of the year.

Pay attention to the deductible, which is the amount you may need to pay toward covered healthcare services before your plan begins paying its share. You'll also want to compare copays, coinsurance, and the annual out-of-pocket maximum.

Think about how you actually use healthcare. Someone who rarely sees a doctor may have very different priorities than someone who regularly needs primary care, physical therapy, specialist visits, medications, or treatment for a chronic condition.

Instead of asking only, "What will this cost me each month?" consider asking, "What could this plan cost me if I actually need to use it?"

Make Sure Your Providers Are In-Network

If you already have healthcare providers you trust, checking the network should be near the top of your Open Enrollment checklist.

One common source of confusion is assuming that because a doctor's office "takes" a particular insurance company, every plan offered by that insurer is accepted. That's not always the case. Insurance companies may offer multiple plans with different networks, and a provider who participates with one may not necessarily participate with another.

When reviewing a plan, look for your primary care provider and any specialists you see regularly in its current provider directory. Before making a final decision, it's also a good idea to contact the provider's office directly with the specific name of the plan you're considering.

That extra phone call before enrolling could prevent an unpleasant surprise when you need care later.

Consider the Healthcare You May Need Next Year

Nobody can predict every healthcare need, but your current health can provide important clues about what you'll likely use in the coming year.

If you manage diabetes, high blood pressure, arthritis, chronic pain, allergies, or another ongoing condition, consider how frequently you typically see a provider and whether you need regular testing or medications.

Think about other services, too. Are you expecting a procedure? Have you been putting off physical therapy? Do you regularly see a chiropractor? Are you establishing care with a primary care provider? Does an old injury tend to flare up?

A plan that looks inexpensive on paper may become considerably less attractive if the services you use most frequently have high copays, require a large deductible, or aren't available through your preferred providers.

Review Your Prescription Drug Coverage

If you regularly take prescription medications, don't assume they'll be covered the same way under a new plan.

Health plans maintain formulas that determine which medications are covered and how much patients pay for them. Medications may be placed into different tiers with different copays or coinsurance requirements. Some may also require prior authorization or have other coverage requirements.

Before choosing a plan, review its current drug formulary and look up the medications you take regularly. If you're comparing several plans, your expected prescription costs can make a meaningful difference in the overall value of each option.

Think About Access, Not Just Coverage

Having insurance and being able to conveniently use it aren't necessarily the same thing.

Look at the provider network in your area. Are there primary care providers accepting new patients? Are the specialists you might need nearby? What happens if you need physical therapy, diagnostic testing, or other follow-up care?

Access becomes especially important when you're managing a condition that requires multiple types of care.

At Advanced Care Specialists, our multidisciplinary model allows patients to access primary care alongside services such as physical therapy, chiropractic care, physical medicine, pain management, allergy care, and other specialties in one location. If having coordinated access to several types of care is important to you, consider that when comparing insurance networks.

Medicare Open Enrollment Deserves a Careful Review, Too

For Medicare beneficiaries, the Annual Open Enrollment Period runs from October 15 through December 7. This is an opportunity to review current coverage and make certain changes for the upcoming year.

Even if you're happy with your current coverage, it's worth reviewing the plan annually. Provider networks, prescription formularies, costs, and benefits can change from one year to the next.

If you're considering changing Medicare coverage, pay particularly close attention to whether the physicians and healthcare facilities you use participate with the specific plan you're considering.

Before You Enroll, Make a Few Phone Calls

Insurance documents can tell you a lot, but they don't always answer the questions that matter most to your individual healthcare.

Once you've narrowed down your options, contact the doctors and healthcare facilities that are most important to you. Give them the exact insurance company and plan name you're considering and ask about current participation. You can also contact the insurance company to confirm network status and benefits.

A little research during Open Enrollment can make a significant difference once the new plan year begins.

If keeping Advanced Care Specialists as part of your healthcare team is important to you, call us at 262-898-9000 before selecting your new coverage. Our team can help you determine whether the specific insurance plan you're considering is one we currently accept.