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September 18, 2009

How to Choose Your Health Plan During Open Enrollment

By Christine Paige

The open enrollment season has arrived, which means millions of workers who have employer-based health insurance will soon select their health care coverage for 2010. Choosing a plan is an important health care decision and a significant financial decision—and it's not one to be made lightly.

Unfortunately, according to a MetLife study, employees typically spend only about 30 minutes considering their options during open enrollment before choosing a health plan for themselves—and oftentimes their families. That's not ideal in the best of times, and during a difficult economy, it's probably more important than ever to choose carefully, and assess your coverage in five specific areas before selecting a health plan:

  1. Review your past health care experiences;
  2. Estimate your health care needs for the coming year;
  3. Consider what you want from your physicians and health care providers;
  4. Determine which online support tools are important to you;
  5. Examine all costs involved in maintaining your health—and the plan's total value.

First, take the time to thoroughly review your past health care experiences. Look at your current health plan and assess its overall value to you and your family. What do you like – and what do you want to change? Are you happy with the level of service and support you receive? In California, we have easy access to independent, online comparisons of health plans' quality and service. The State of California Office of the Patient Advocate (www.opa.ca.gov) offers ratings of plans based on the quality of care members receive and what members say about their care.

Next, assess your health-care needs for coming year. What has changed for you in the past year, and what changes are coming next year? For example, maybe you've developed a chronic condition that will require more doctor visits or prescriptions. Or maybe you plan to have a baby. Review your options based on how you live your life.

Next, evaluate a plan's care delivery system or network based on your specific needs. You want a physician, hospital or care delivery system that meets your health needs. Do you want the option of going to a large network of doctors, specialists and hospitals? Do you prefer an HMO or a PPO?

You should also understand the full extent of what a plan offers in terms of online tools. Consumers have more demands on their time, and they want easier and faster access to information so they can manage their health at their convenience.

At Kaiser Permanente, for example, our members can e-mail their physicians; order prescriptions online; view their test results; and can make appointments for themselves and family members at their convenience – at no additional cost.

Finally, consider all of your health-care costs and services before selecting your plan. Don't automatically sign up for the plan with the lowest premium. Look at the total value you are getting in terms of services and costs. How much did you spend on health care in the past year—including premiums, deductibles, co-pays for physicians, hospital stays and prescriptions? And what did you get for it?

Then, look at your options for the coming year. What services does the plan provide? What are the plan's co-pays for office visits, hospital visits and prescription drugs? What is the deductible and out-of-pocket maximum for each plan? Is there a maximum benefit? Once you know the answers to these questions, you’ll be prepared to find the health plan that's right for you.

It takes time to be an informed health-care consumer, but it’s definitely time well spent.


Christine Paige is a senior vice president for Kaiser Permanente.