Choosing a Health Plan? Start With the Care You Want
Check doctors, hospitals and services before enrolling
Check doctors, hospitals and services before enrolling
Key Takeaways
- Start with your health care needs when choosing a plan.
- Check access to preferred doctors, specialists and hospitals.
- Consider convenient care, including virtual visits.
- Confirm your providers are in network before enrolling.
Choosing a health plan is not just about having coverage. It is also about how easily you can get care when you need it.
During open enrollment, think about how you and your family prefer to get care. That may mean having a primary care doctor nearby, access to specialists, a hospital you trust and virtual care when an in-person visit is not needed.
“When choosing a health plan, start with the care you want,” says Anil Keswani, MD, corporate senior vice president and chief medical and operations officer for ambulatory care at Scripps Health. “Make sure the plan gives you access to the doctors, specialists and hospitals that are important to you and your family.”
Considering your family’s healthcare needs and preferences can help you choose a plan that makes it easier to get the care you need throughout the year.
Start with primary care
Primary care is often the starting point for staying healthy and getting help when something changes.
A primary care physician (PCP) can provide preventive care, evaluate new symptoms, manage medications and help with ongoing health conditions. Your PCP can also coordinate care with specialists.
If you already have a doctor you trust, check whether that physician participates in the plan you are considering. If you need a new PCP, learn about the different types of primary care doctors, including family medicine, internal medicine and pediatrics.
Also consider how easy it will be to get care. Are appointments available when needed? Is the office convenient? Are virtual visits available when appropriate?
Check access to specialists
If you see a cardiologist, endocrinologist, orthopedist, oncologist or another specialist, check whether that physician and medical group participate in your plan.
A new diagnosis or injury may also require specialty care you do not use today. Consider whether the plan gives you access to needed specialists, whether care can be coordinated within the same health system and whether a primary care physician referral is required.
Consider the benefits of connected care
It can also help to consider whether your doctors are part of the same health system. When primary care, specialists, hospitals and digital services are connected, it can be easier to coordinate care, share health information and get the services you need.
At Scripps, primary care and specialty physicians can coordinate your care within the same health system, helping provide a more seamless experience as your health needs change.
Make sure your preferred hospital is covered
Hospital access is another important part of choosing a health plan.
Think about where you would want to go for:
- Emergency care
- Surgery
- Maternity care
- Imaging and procedures
- Cancer treatment
- Intensive care
- Other advanced specialty care
If you have a preferred hospital or health system, check whether it participates in the specific health insurance plan you are considering.
Families may also want to consider pediatric specialty care. For example, Scripps provides neonatal intensive care in partnership with Rady Children’s Hospital San Diego for newborns who need specialized care after birth.
Knowing what hospital and specialty care is available can give you a clearer picture of how a health plan would work for your family.
Look for convenient care options
Choosing a health plan is about more than having access to doctors. It also means being able to get care when and where you need it.
Consider whether clinics are close to home, work or school. Are appointments available when you need them? Are office hours convenient
At Scripps, care options include HealthExpress walk-in clinics, urgent care and same-day virtual care for certain health needs.
If you have an ongoing health condition, staying connected with the same care team can also make follow-up visits and treatment easier to manage.
Explore virtual and digital care options
Depending on the health system and your coverage, digital services may include video visits, online scheduling, secure messaging, prescription refill requests and access to test results.
These tools can help you manage routine health needs, get answers to questions and receive follow-up care without an in-person visit when appropriate.
At Scripps, patients can use MyScripps to schedule appointments, access Video Visits, view test results, request prescription refills and communicate their care team.
Confirm access before you enroll
Before making a final decision, review the details of each health plan to make sure it fits your needs.
Provider networks can vary by plan and change over time. Costs also matter, so compare monthly premiums, deductibles, copays and out-of-pocket limits.
“Before enrolling in a health insurance plan, confirm that your preferred doctors and hospitals are in network,” Dr. Keswani says. “If you want to receive care at Scripps, make sure Scripps is included in the specific plan you are considering.”
Make an informed health plan choice
The right health insurance plan should do more than provide coverage. It should give you access to the doctors, services and care options that matter most to you.
“Open enrollment is a good time to think about how you and your family actually get care,” Dr. Keswani says. “Look beyond the monthly premium and consider whether the plan gives you access to the doctors, specialists, hospitals and services you may need.”
Starting with those priorities can help you choose a health plan that fits your needs and makes it easier to get care throughout the year.