A lot can happen over a year. Your health, budget, life situations, and more can all change. Open Enrollment is a great time to reassess your needs and ensure your current health plan meets them. As you prepare to make your selections for coverage, use this checklist to help you see if your current health plan is working for you, your health, and your budget.

Here are five key health plan areas to check: 

1. What’s Covered 

Coverage, in health insurance terms, is the costs from your medical services and prescription drugs that your health plan pays. What and how much is covered under your health plan can change from year to year, and what you need covered can also change. For example, having a baby, getting married, getting divorced, and major changes in health needs, all can impact the type of health plan you need.   

Your health plan gives you a Summary of Benefits and Coverage (SBC) each year. This document is an easy-to-understand overview of benefits and coverage provided by your health plan. Before you make your choices, it’s a good idea to review the SBC through the lens of your needs now rather than what you needed a year ago. If you need help finding a copy of your plan’s SBC or understanding it, we’re here to help. CalVEBA members can access their plan information online at MyVEBA.

2. How Much Are Your Costs?

Take a moment to review your total health care costs over the past year. Were there any costs that were higher than expected? Are there any trends? Consider whether you anticipate these trends to stay consistent, rise, or decrease. If you anticipate needing more care next year and expect higher expenses, it’s important to determine if your current plan effectively manages those costs. Additionally, if your financial situation changes, your current plan may become unaffordable for you.  

When looking at health care costs, remember, there’s more to the total than monthly premiums. Total costs of care over the year include monthly premiums, deductibles, copayments, coinsurance, and out-of-pocket maximums. (Read this blog for definitions of these terms.) Review your expenses for each category over the past year to determine if your current plan meets your budget needs. Consider any anticipated increase in care for the upcoming year as well. 

3. Is Your Care Team In-Network?

Selecting your care team — a team of health care professionals like primary care providers (PCP) and specialists that you choose to go to for care — is a personal decision. You need to feel comfortable with them as a person and confident in them as a professional.

When selecting providers and facilities, ensure they are within your health plan’s network. By choosing in-network providers and facilities, that have contracted agreements with health plans and offer services at reduced rates for plan members, you can save money. 

If you’re not happy with your providers, get recommendations from friends and family and then check if they are in-network for your health plan. Your comfort in seeking and receiving care is very important. Take time to make sure you’re getting what you need from your care team while still protecting your budget with your plan’s network. 

4. What’s the Customer Service Like?

During this time of year, reflect on your experience with your health plan carrier. No company, system, or process is perfect, but you deserve the totality of your experience to work for you.

Have an issue with your health plan carrier you need assistance with? Reach out to The CalVEBA Advocacy Team here or call 888-276-0250. 

5. What Prescription Drugs Are Covered?

Health plans may include prescription drug coverage. You can find what’s covered and how much in your plan’s formulary or list of covered drugs. You can access this formulary on your health plan’s website, by contacting your health insurance provider directly, or reviewing the documentation provided to you when you enrolled in the plan. If you take prescription drugs or anticipate being prescribed any soon, you’ll want to review this list as coverage and costs may change year to year. 

Remember, it’s important to take your medication as your doctor prescribed — at the right times and in the right amounts. Don’t stop your medication without talking to your provider. Take this time to thoroughly review your prescription drug coverage and what that means for your health and your budget. It may still work for you, or you may need to pick a different plan for next year.