Families consider many factors when choosing a health care plan. (Shutterstock illustration)

What to Consider When Choosing a Health Plan

Local experts provide tips for employee and employer

Back Article Sep 21, 2022 By Judy Farah

This story is part of our September 2022 print issue. To subscribe, click here.

It will soon be time for open enrollment. Choosing a health care plan can be daunting, as can not knowing which doctor or health care company best suits you or your family’s needs. Companies compete to be your provider, inundating you with pamphlets, emails and media commercials. Comstock’s talked to some local experts who provide tips for both the employee and employer.

Dr. Bianca Roberts with Dignity Health says the best way to start is to choose your primary care physician. Go through the company’s websites and find one that appeals to you. Roberts says doctors at Dignity Health provide not only their health specialities, but also their philosophies of care, personal interests and hobbies so you know more about them. 

Dr. Bianca Roberts of Dignity Health recommends identifying a primary care doctor with whom you connect as the first step to managing your health.

“The primary care physician is actually the doctor who will coordinate and manage your overall health. We keep everyone up to date on all their health screenings and manage complex illnesses as well,” says Roberts. “It’s really important to pick a primary care doctor that you’re comfortable with.”

Choosing a doctor becomes easier when you break it down. Do you have a gender preference? Do you want someone close to your home or place of work? Or do you take care of a family member and want to be closer to them? Health care has seen a substantial increase in virtual visits, and if you prefer that, seek out physicians who provide telemedicine. 

If you have a medical condition such as heart ailments or cancer, Roberts advises looking around to see which health care company specializes in that treatment. Your physician will also refer you to a specialist in that area. 

Costs are a big concern these days. Roberts says you shouldn’t just look at costs, but at the value as well. Families who provide health care for their children should also consider a provider’s urgent care services.

“Look at Medicare ratings. Each medical group is rated by Medicare for their ability to not only keep patients out of the hospital, but to manage (them) to  really provide cost savings by how well they do health screenings and preventive care, manage blood pressure and other kinds of things to keep a population healthy,” Roberts says.

Erin Ocheltree is the director of benefits for Bender Insurance Solutions, which designs benefit programs for employers. Ocheltree says it’s important for employers to listen to their workers’ needs when creating health plans for them.

“Typically, we’re thinking first. We’re always asking what are your pain points? What’s working well and what’s not working for you? What are your goals — budget, morale, retention of employees or acquiring new ones?” Ocheltree says.

Bender creates health plans tailored to a company’s needs, and these days companies are offering more for workers to retain them, such as providing payments for mental health checkups, therapy or wellness such as gym memberships. The pandemic also changed health care with more people seeking wellness programs and telehealth.

“I think it’s important for employers to know the health and wellness of their employees directly affects how well they perform for the employer. So spending a little bit of money to provide someone something valuable, like a gym membership or some money toward therapy, is a pretty worthwhile investment.”

“You want to create custom solutions for them (employers), so that they’re providing benefits to their employees. Every employee can have different needs.”

Companies like Bender that design medical benefits for employers typically offer two or three health care companies for employees to choose from. They also provide enrollment systems to help employees set up their health care accounts.

“Everyone has a different need when it comes to medical insurance. Someone who’s a high utilizer or had an ongoing medical condition is going to want a different plan than someone with young children or someone who’s single and doesn’t use their benefits as much. It’s important for all those people to have coverage,” Ocheltree says.

Open enrollment is Nov. 1st through Dec. 15th, so take time to find one that best suits you.

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