Originally published in The Tennessean, October 2021
Do you buy your own health insurance apart from an employer? Open enrollment season is upon us, and there’s a lot to think about.
Whether you’re looking for a Marketplace plan on Healthcare.gov or are a senior considering your Medicare options, picking the right plan can improve your physical and financial health.
You can make the most of your time by preparing a list of services you use the most, doctors and hospitals that are important to you, and your prescriptions. Then, here’s how to assess your individual needs and find the right plan for you.
Let’s start with Affordable Care Act (ACA) Marketplace plans.
Shopping on the Marketplace
If you’re under 65 and looking for a health plan, you’ll use Healthcare.gov during open enrollment, which runs from Nov. 1, 2021 through Jan. 15, 2022.
While it’s easy to focus on what your monthly premium will be, make sure to compare your estimated yearly costs between plans — and account for deductibles and copays.
One important factor to consider is whether you’re eligible for financial assistance for your premiums or even out-of-pocket expenses. That depends on your household income, which you can enter as you shop on Healthcare.gov – and the majority of Marketplace consumers in Tennessee tend to qualify for at least some financial help.
As you browse plans, you can also add your preferred providers and common prescriptions to see whether they’re covered. BlueCross is offering a new network option, Network L.
In Knoxville, Network L features UT Medical Center hospitals and University Physicians’ Association, Inc. doctors.
In Memphis, Network L plans feature Baptist Memorial Health System and offers enhanced benefits for choosing primary care services with our partners at Sanitas Medical Centers.
In Nashville, Network L plans feature Ascension Saint Thomas Health System and offers enhanced benefits for choosing primary care services with our partners at Sanitas Medical Centers.
And don’t forget that quality counts — BlueCross has the only commercial health plan in the state that earned a 4-star rating from the National Committee for Quality Assurance.
Even if you’ve purchased a plan before, don’t be content to just roll into the same plan. Plan benefits and costs change somewhat every year, so invest the time to refamiliarize yourself with what you have and whether it’s still the best choice for you.
Deciding on a Medicare plan
Medicare enrollment is open through Dec. 7, and seniors looking at Medicare plans should weigh five factors when selecting their plan.
Time: The first step for accessing your Medicare options should be creating an account on ssa.gov. You’ll then receive confirmation of your Medicare Beneficiary Identifier and have what you need to begin the process of enrolling in a Part D plan, a Medicare Supplement plan or a Medicare Advantage plan.
Cost: What’s the plan’s monthly premium, and is it within your budget? Are there copayments or coinsurance for the services you use most? What’s the projected cost of your prescription drugs? All of these can vary depending on the plan.
Network: Make sure your preferred hospital and health care facilities, your primary care provider, any specialists you see, and your pharmacy are covered.
Extras: This commonly refers to dental, vision and hearing aid benefits. Some plans also include meals following a hospital stay and gym memberships.
Quality: It’s important to know on the front end what standards the plans you’re considering have met. For example, every year, Medicare evaluates plans based on a 5-star rating system.
At BlueCross, our BlueAdvantage PPO plan just earned a 4.5-star rating from the Centers for Medicare and Medicaid Services, reflecting our members’ overall satisfaction and our commitment to ensuring they get the right care.
And we were named one of the best Medicare Advantage plans by U.S. News and World Report.
Many plans — including ours — offer in-person and virtual meetings and educational sessions to help shoppers understand the different offerings.
Remember, plan shopping should be a “selfish” endeavor. For your long-term health and financial security, carefully considering your options will bring its own benefits.
Todd leads the team managing our provider agreements, operations, data, and innovation that impact provider reimbursement and relationships across our commercial, Medicaid and Medicare line of business. He also leads the team managing and operating our 4-STAR quality rated Medicare Advantage plans and our Medicare Supplement products.