by Ashleigh Norris and Alexa Bluth
As the season turns to fall, minds are often on school, football, and even the upcoming holidays. But this is also the season of open enrollment, a period of weeks or months to enroll in or change health insurance or coverage for the year ahead. Open enrollment is relevant for all types of health insurance, whether you are covered through your employer, on your own, with Medicare or through the Affordable Care Act.
“People have a lot of options to choose from during open enrollment,” said Tim Lieb, senior vice president of Growth at Blue Shield of California. “It can feel overwhelming to navigate, so I always recommend exploring the tools offered by health plans, employers, and the state or federal government to help choose a plan that will best fit your specific health care needs.”
Types of Plans
In choosing health insurance, there are three main plan types: Preferred Provider Organizations (PPO), which typically have higher premiums but offer more flexibility for seeing specific doctors and specialists in and out of network; Health Maintenance Organizations (HMO), which have lower premiums but require you to see doctors within the network and get referrals for specialty care; and High Deductible Health Plans (HDHP), which typically have low premiums and high deductibles on a PPO plan design.
As you are reviewing your options, there are several important things to keep in mind:
Consider your budget and the coverage you need
- Financial coverage: In thinking about which type of plan is right for you, think of how much you typically spend on healthcare costs.
- Network: Check to see if the health care providers you use are in network and consider whether or not you would like to be able to access providers outside of your network.
- Retail and mail-order prescription drug coverage: Prescription drug coverage determines how much you will pay out of pocket for your medicines and whether your plan offers any discounts or an option to receive some prescription drugs in the mail or by delivery.
- Health care spending accounts: Open enrollment also can offer a chance to consider opening a pre-tax account for your health care needs, either a Flexible Spending Account (FSA) or Health Savings Account (HSA). FSAs are offered through employers, and an HSA is an investment account for those with high deductible health plans.
- Dental and vision coverage: Research which dental and vision plans are offered and what they cover, such as preventive care, screenings, and treatments.
Make sure you can access services to help stay on top of your health
- Preventive services: These can include tests or health screenings, prevention-focused checkups and immunizations. Preventive care is critical to maintaining health and avoiding potentially life-altering conditions, and many preventive services ― such as annual wellness visits ― are offered at no out-of-pocket cost for members.
- Diagnostics and lab work: These can include certain tests such as bloodwork, cultures and urinalysis.
- ER/Urgent Care: Different plans offer different benefits for care that is needed after-hours or on an emergency basis. For example, many Blue Shield members can get in-home, same-day, high-touch care delivered by trained medical professionals.
- Mental health: Mental health benefits often cover counseling, treatment or medication for certain behavioral health needs such as depression, substance abuse or anxiety.
- Virtual care options: For many people, such as working adults or those who have limited transportation, it is important to have access to virtual care visits with providers via phone or video call. Earlier this year, Blue Shield launched a virtual-first plan called Virtual BlueSM, designed to expand access to high-quality, integrated virtual primary, behavioral, specialist and urgent care, supported by an in-person network. Teladoc also offers a variety of telehealth services, including urgent and emergency care.
- NurseHelp 24/7SM: Another type of service you can utilize in your own home, this healthcare advice phone line offered by Blue Shield provides reliable health advice and information from registered nurses.
- Customer service/call center: This can be helpful if you need to reach someone to help answer your health coverage questions. Many plans, including Blue Shield’s Trio HMO, offer concierge services to help members navigate care, schedule appointments and more.
- Well-being programs: Many plans offer wellness programs such as mental health support, weight loss and smoking cessation programs. Blue Shield, for example, offers Wellvolution®, a personalized digital program for health and well-being with apps and programs at no extra cost.
“One of the things people may not realize about health plans is that they actually offer a lot of programs, completely free, that provide services that may be harder to find in your network of care,” Lieb said.
Once you’ve considered your needs and budget, you can select the best plan for you and your family. And then you can go ahead and watch that game or plan for the holidays.
To learn more about the options Blue Shield of California offers, explore plans on our website.
Virtual BlueSM is a service mark of Blue Shield of California.
NurseHelp 24/7 is a service mark of Blue Shield of California. NurseHelp 24/7 is a healthcare advice line. Nurses do not provide medical services for treatment or diagnosis.
Wellvolution is a registered trademark of Blue Shield of California. Wellvolution and all associated digital and in-person health programs, services, and offerings are managed by Solera, Inc. These program services are not a covered benefit of Blue Shield health plans and none of the terms or conditions of Blue Shield health plans apply. Blue Shield reserves the right to terminate this program at any time without notice.
You may receive services from network providers on an in-person basis or via telehealth, if available. Contact your primary care provider, treating specialist, facility or other health professional to learn whether telehealth is an option. Network telehealth and in-person services are subject to the same timeliness and geographic access standards. If your plan has out-of-network benefits, they are subject to your plan’s cost-sharing obligations and balance billing protections.