Finding the Right Doctor and Health Plan for You (video)

During open enrollment, you can sign up for a new health insurance plan for yourself and your eligible family members, make changes to your current coverage or plan, or cancel your coverage.

Open enrollment happens once a year; the exact time depends on the type of health plan you have. For health plans provided by employers, the open enrollment period is typically in October or November. Open enrollment for Covered California health plans runs from November 1 to January 31. Most choices take effect on January 1 of the next year.

Knowing when your open enrollment period begins and ends is important, because if you miss it, you’ll have to wait until the next year to make changes unless you have what is called a “qualifying event” that affects your family, such as a marriage, divorce, birth or adoption; in that case, you can adjust your coverage accordingly.

“It’s an important time of the year because it gives you a chance to look at your plan options and what’s covered in each plan,” says Dr. Keswani. “In addition to choosing the company that will provide your insurance, you’re choosing who will provide your care and where. So, you want to make these decisions carefully.”

Different types of plans offer different levels of coverage and costs. HMO plans are usually the least expensive but also may be the most restrictive. With an HMO, you’re required to choose a primary care provider; if you want to see a specialist, you will need approval from your HMO first, and you will be limited to physicians within the plan’s network. If you see a doctor outside the network, insurance will not cover the cost.

A PPO plan is usually more expensive, but generally allows you to see specialists without prior approval, and often has a broader network of doctors and hospitals from which to choose.

For many people, the most important decision is choosing their doctor. If you already have a physician and you are happy with them and your plan, you may not want to make any changes. However, if you decide to change plans for some reason, make sure your physician is covered by whichever plan you choose.

“If you don’t have a doctor you like, this is a good opportunity to find one that meets your needs,” says Dr. Keswani. “Ask your friends if they have physicians they recommend. If you want a Scripps doctor, call 1-800-SCRIPPS and ask for a physician referral, and we’ll help match you with one who provides the type of care you need in the location that’s convenient for you.”

Also consider these questions:

• Do you prefer a specific hospital? Is it covered in the plan? If not, are the hospitals in the plan convenient for you? Do you have a choice of more than one location?
• If you have to see a specialist, is there a large network to choose from? Are they conveniently located?
•  Are there urgent care, express care and emergency care locations near your home?
• Are the medications you’re taking in the plan? Are brand-name prescription drugs covered, or only generic?
• Is behavioral or mental health care included?
• If you use services, such as chiropractors or acupuncturists, are they covered?

“Also, think about the year ahead. Are you planning to have a baby? Do you plan to have surgery, such as a knee replacement or heart surgery? Do you want a specific surgeon?” says Dr. Keswani. “It can be hard to plan that far ahead, but it’s a good idea to consider the possibilities before you make your choices.”

Making informed health plan choices can help you stay well and get the care you need. While open enrollment can seem complicated, help is available. If you have questions about your options, the representatives at 1-800-SCRIPPS can help.