Jacks: do your homework;  a guide to health insurance for families

Jacks: do your homework; a guide to health insurance for families

By Dr. Tim Jacks | Pediatrician at Gilbert Pediatrics

Open enrollment for the 2023 benefit year is now upon us, giving many people the opportunity to assess their health care options for the year ahead.

It’s not a simple process for anyone. Those on employer-provided benefits are likely looking at multiple health packages and noticing a further increase in their share of the bill. Others can search healthcare.gov for the right plan for their family, but the health insurance market presents its own set of problems. In Arizona, many of the major insurers have exited the market, limiting options for residents.

To make matters worse, most insurance companies are posting double-digit rate increases, which is hitting the wallet hard. All of this is straining family budgets – especially amid the rising cost of living – and many of us are getting sticker shock from high co-payments, deductibles, coinsurance and premiums.

If you’re like most people, you might be tempted to choose your insurance with your wallet, but it’s important to weigh the cost against the quality of care, access to trusted doctors, and even proximity – especially if you or a member of your family have a complex or chronic condition. If so, choosing medical coverage is one of the most important decisions you’ll make all year.

Doing homework is vital. When choosing your health plan for 2023, follow these steps to ensure you choose the best plan for your family. Most importantly, remember that you will have to live with your choice for an entire year, so be very careful with this decision.

1. Make sure your provider is networked. We often rely on trusted primary care doctors and, in many cases, dedicated specialists. Don’t assume that your doctors will be networked because insurance plans change every year. Make sure your suppliers agree to the plan you are considering.

2. Beware of narrow networks. Among the health insurance products for sale are very limited plans that offer lower premiums in exchange for extremely tight provider networks. Close networks are a good solution for many people, but they can be disastrous for people who experience a serious injury, illness, or have complex or chronic health needs. In fact, despite a low listed price, choosing a close network can result in higher costs if a family member needs to see a specialist or receive treatment outside of the network.

3. Do the math. Low premiums may be tempting, but the cost of health care goes far beyond the monthly payment. Also be sure to factor in your share of costs for doctor visits and medications. For some families, especially those who need specialist care or ongoing medical treatment, it may be more cost effective to purchase a plan with a higher monthly premium that covers a greater share of healthcare costs through at a lower deductible, coinsurance or coinsurance. Payment.

4. Consider the “extras”. Some plans have an option for a Health Savings Account or a Flexible Savings Account. You can fund these accounts before tax to cover health care expenses. Plans may also offer benefits such as care coordination services and healthy lifestyle benefits, which may also be important considerations in your decision-making process.

5. If you have questions, ask them. Contact your broker, human resources manager or plan provider if you have any questions about your plan. You can also call Phoenix Children’s Family Financial Services at 602-933-2000. This free program helps families understand their coverage options and choose a plan that meets their needs.

Editor’s Note: With offices in Mesa and Gilbert, Gilbert Pediatrics is part of the Phoenix Children’s Care Network, which includes more than 1,175 pediatric primary care providers and specialists who provide care in more than 75 subspecialties. The PCCN also includes Phoenix Children’s Hospital as well as primary and specialty care clinics, urgent care clinics, surgery centers and sports medicine sites throughout the region.

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