After Open Enrollment: What to Do Next
Steps to take after choosing your health insurance plan
Steps to take after choosing your health insurance plan
Key Takeaways
- Confirm when your new health coverage begins and look for your insurance card.
- Make sure your doctors, facilities and prescriptions are covered under your plan.
- Review your benefits, deductible and out-of-pocket costs to avoid surprises.
- Check upcoming appointments for network coverage, referrals and prior authorizations.
Open enrollment season is a good time to review your health coverage and make sure your plan still fits your needs. Once you choose a plan, there are a few important steps to take before you start using your benefits.
Whether you enrolled through work or chose an Affordable Care Act (ACA) plan through Covered California, review your plan details soon after enrollment. Confirm when coverage begins, look for your new insurance card and check your doctors, prescriptions and benefits.
“Taking time to understand your coverage now can help prevent surprises later,” says Anil Keswani, MD, corporate vice president and chief medical and operations officer for ambulatory care at Scripps Health. “Knowing which doctors are in-network and how your benefits work can make it easier to use your health plan when you need care.”
Know when your new coverage begins
Many health plans selected during open enrollment take effect at the beginning of the new year, but your start date depends on when and how you enrolled. Check your insurer, employer or Covered California account for your plan’s effective date and confirm that any required first premium has been paid.
Do not cancel existing coverage until you know when your new plan begins. Even a short gap can create problems if you need a prescription refill, medical appointment or unexpected care.
Look for your new insurance card
Your insurer will typically send an insurance card after your enrollment is processed. Depending on the plan, the card may include your:
- Member ID
- Plan name
- Group number
- Copay information
- Prescription information
- Customer service phone number
Review your card when it arrives and make sure your information is correct. If you have not received it by the time your coverage begins, contact your insurer. You may also be able to access a digital insurance card through your insurer’s website or app.
Create an account with your health insurer
Set up an online account once your enrollment is complete. Depending on your plan, you may be able to use it to:
- Download a digital insurance card
- Review your benefits
- Search for in-network doctors and facilities
- Check claims
- Find covered medications
- Track your deductible and other health care spending
Keeping this information in one place can make it easier to manage your coverage throughout the year.
Confirm your doctors are in-network
A doctor may accept insurance from your insurer but not participate in every health plan or provider network it offers.
Use your insurer’s provider directory to search for your doctors under the exact name of your plan. You can also contact the doctor’s office and your insurer to confirm that the doctor and facility are in-network before receiving care. If you plan to receive care at Scripps, you can also confirm whether Scripps is included in your health plan.
“Insurance networks can vary from one plan to another, even within the same insurance company,” says Dr. Keswani. “Before an appointment, confirm that both your doctor and the facility are in-network under your specific plan.”
Choose or confirm your primary care doctor
Your plan type can affect how you choose and use a primary care doctor. HMO plans often require members to select or be assigned a primary care physician who coordinates care and referrals. PPO plans generally offer more flexibility and may not require you to designate a primary care doctor.
Check your plan rules to see what applies and make sure any doctor you choose is in-network. If you have an HMO, consider what to look for when choosing a primary care doctor in your network, including location, availability and access to specialists.
Check your ongoing prescriptions
If you take prescription medications regularly, review how your new plan covers them before your next refill.
Check:
- Whether the medication is on the plan’s formulary
- Which pharmacies are in-network
- Your expected copay or coinsurance
- Whether prior authorization is required
- Whether other coverage requirements apply
Prescription coverage, costs and requirements can differ between plans. If you have questions, contact your insurer, pharmacist or prescribing doctor before you run low on medication.
Understand your deductible and out-of-pocket costs
Knowing what your plan covers is only part of understanding your new insurance. Review what you may be expected to pay when you receive care.
Important costs may include:
- Premium: The amount you pay to maintain your health coverage.
- Deductible: The amount you generally pay for certain covered services before your plan begins sharing the cost.
- Copay: A fixed amount you may pay for a service or prescription.
- Coinsurance: A percentage of the cost you may pay for covered services.
- Out-of-pocket maximum: The most you generally pay for covered in-network care during the plan year before your health plan pays the full cost of covered benefits.
Your Summary of Benefits and Coverage can help you understand these costs and how your plan works. If you are comparing coverage again in the future, consider total costs along with provider networks, prescription coverage and other benefits rather than looking only at the monthly premium.
Review other health plan benefits
Take time to review benefits beyond doctor visits and prescriptions. Your health insurance plan may include preventive care, mental health services, urgent care, telehealth, wellness programs and other resources.
Many plans cover certain preventive services, such as annual checkups and recommended screenings, with little or no out-of-pocket cost when you use an in-network provider. Coverage can vary, so check your plan documents before scheduling care.
It is also helpful to know where to go for nonemergency care. Understanding your options for primary care, urgent care and virtual visits can help you choose the right setting and better anticipate what you may pay.
Review upcoming appointments
If you already have medical appointments, tests or procedures scheduled, review them before your new coverage begins.
Confirm that:
- Your doctor and facility are in-network
- Specialists meet your plan’s requirements
- Referrals are in place if needed
- Procedures, imaging or medications have any required prior authorization
If your insurance is changing, give your new information to your doctor’s office before your appointment. Checking these details ahead of time may help prevent delays or unexpected bills.
At Scripps, you can also use MyScripps to review upcoming appointments and manage other details related to your care.
What if you chose the wrong health plan?
If your plan does not meet your needs, act quickly. You may still be able to switch plans while open enrollment is underway. After the deadline, your options are more limited unless you qualify for a Special Enrollment Period.
If you have employer-sponsored coverage, contact your human resources or benefits department. For enrollment errors or incorrect application information, contact your insurer or Marketplace as soon as possible.
If you need to wait until the next open enrollment period, use what you learned from your current plan to guide your next choice.
What if you missed open enrollment?
You may still have options if you miss the deadline. Certain life events, such as losing other coverage, getting married, having or adopting a child or moving, may qualify you for a limited-time Special Enrollment Period.
If you do not qualify, you may need to wait until the next open enrollment period. Eligible Californians can apply for Medi-Cal year-round.
Employer-sponsored plans have their own enrollment rules. If you miss a workplace enrollment or experience a qualifying life event, contact your human resources or benefits department to learn what options are available.
Keep your health plan information handy
Save your insurance card, Summary of Benefits and Coverage, enrollment confirmations, payment records and other plan documents somewhere easy to find.
It can also be helpful to keep your insurer’s customer service information readily available in case you have questions about coverage, costs or network participation.