Open Enrollment - It's here and we're here to help you.

During this open enrollment season, you have an opportunity to connect with award-winning doctors to keep you and your family healthy. Changes in health care are common, so it’s always smart to consider your options.

Many employers make open enrollment available to employees during the fall months. Sometimes, health plan options change through your employer. When this happens, you will need to choose a new plan. When choosing, be sure to select a plan that gives you access to one of our MemorialCare doctors. Your benefits administrator can tell you what your health plan options are, as well as enrollment deadlines.

For retirees, having the right health plan gives you freedom that only good health can provide. It’s knowing your health is not just your priority, but also the priority of the doctors and providers you’ve chosen. Have you thought about whether your current coverage still meets your needs? Medicare Annual Election Period runs every year from October 15 through December 7. This is your opportunity to choose from among the best plans with little or no additional out-of-pocket expenses. The annual election period will be here before you know it, so take advantage of the time left to be certain all your health needs will be met in the new year.

Whether you are choosing an employer sponsored plan, a Medicare plan, or a private plan “on or off” the Covered California Exchange, it is a good idea to first review your current plan in order to make informed comparisons with new options. Here are some questions to ask when you are reviewing your current plan:

  • What did and didn’t work this year?
  • Do I anticipate any major medical needs for next year, such as surgery, medical equipment, pregnancy, etc.?
  • Do I foresee any new medications and what tier will they be on the plan formulary?
  • What were my out-of-pocket costs for this year, (include premiums, co-pays, deductibles and payments for non-covered services)?

Once you have answered those questions, new plan options can be evaluated with these additional questions:

  • Do I want to keep my family physician and if I do, can I?
  • What is the trade-off between possible premium costs and out-of-pocket expenses such as co-pays, deductibles, etc.?
  • Are the costs “up-front” or as I use the services?
  • Will this plan work better for me/us?

Choosing the Right Physician

An equally important part of the process is choosing a health care provider. Ultimately, the value of the health plan option you select is determined by the quality of the physician who delivers the care and administers the medical benefits.

“They all say they’re good doctors, so how do I know who the best is for me?”

As with health plans, you should research and ask questions about the physician you are considering. Getting recommendations from family and friends is a good place to start. For fact-based information, look to un-biased sources.

Independent, third-party organizations such as Integrated Healthcare Association (IHA), California Cooperative Healthcare Reporting Initiative (CCHRI) and the Office of the Patient Advocate (OPA) of California, among others, routinely survey patients and publish service and quality of care ratings on physicians and physician groups. You can visit these websites to investigate the scores and grades given to the physicians.

Look for More from Your Health Care Provider

Along with high ratings from independent sources, you can maximize your plan benefits by looking at what the health care provider has to offer in the way of convenience, services and best practices. Look for a great full-service health care provider who provides:

Access to Care:
  • Same day appointment availability
  • Urgent care access at the same co-pay as an office visit and with no pre-authorization needed
  • Flexibility to be seen near work or home
  • 24-hour telephone access to a nurse advice line
  • Onsite lab and x-ray
  • Connectivity to award-winning hospitals
  • Fully credentialed specialty physician network
Up-to-Date Technology and Practices:
  • Best practice, evidence-based medicine
  • An electronic medical record (EMR) system connecting patient, physician, urgent care, hospital and other services
  • Online (email) communication with physicians and the office
  • Access to medical records and test results
  • Electronic transmission of prescriptions to pharmacies
  • Specialty nurses to assist and follow patient care whether in the hospital or at home

Even if you decide not to make a plan change, having gone through this review process can bring you peace of mind by knowing you chose the right health plan. To learn more about access to MemorialCare, visit here.