By: Jay W. Lee, M.D., M.P.H., Assistant Program Director, Family Medicine, Long Beach Memorial

Open enrollment will take place over the next few months. Employers may offer a variety of health plan choices for the coming year: keeping the same plan, changing to new plans or opting to let employees use individual plans.

For retirees, Medicare’s Annual Enrollment Period (AEP) also arrives Oct. 15 and will end Dec. 7, 2015. With few exceptions, this is the one time of year Medicare beneficiaries can change their coverage for the following year.

Regardless of whether people 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 their current plan in order to make informed comparisons with new options. Questions to consider:

  • What did and didn’t work this year?
  • Do I anticipate any major medical needs for next year, such as surgery, medical equipment, 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 those questions are answered, 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 selected is determined by the quality of the physician who delivers the care.

Research and ask questions about the physician being considered. Recommendations from family and friends is a good start. For objective fact-based information, look to unbiased sources, such as independent, third-party organizations including Integrated Healthcare Association (IHA), California Cooperative Healthcare Reporting Initiative (CCHRI) and the Office of the Patient Advocate (OPA) of California.

Look for More from Your Health Care Provider

Patients can maximize their plan benefits by looking at what the health care provider has to offer in the way of convenience, services and best practices.

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 registered 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
  • 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 no plan change is made, having gone through this review process can bring peace of mind by knowing the right health plan was chosen.

When you select a doctor, you’re determining the entire course of your health care — including the hospital you’ll go to for care.

When you choose a health plan with a physician affiliated with Long Beach Memorial, you have access to a medical center that earns top honors. Call 800-MEMORIAL to find your physician.