Our Choose Smart California Checklist is here to help you through Open Enrollment

My Patient Rights > Our Choose Smart California Checklist is here to help you through Open Enrollment

Our Choose Smart California Checklist is here to help you through Open Enrollment

It should go without saying that finding a health plan that is right for you is important. Fortunately, Open Enrollment is the best time to explore plan options and determine what you and/or your family will need. Whether you are happy with your plan, or interested in switching, use the Open Enrollment period to make sure you are getting the care you need and deserve.

As a patient, you have rights, but do you always know what they mean? It’s important you understand some of the key terms insurers employ to describe plan benefits so you can avoid any confusion when it’s time for a check-up, specialist test, treatment or otherwise. Below are a few terms you should be familiar with as you shop around during Open Enrollment:

Copayment: A fee you pay each time you see a doctor or fill a prescription. Looking to see how high your copayment is for certain services will give you an idea of out-of-pocket costs you may accumulate when seeking care.

Deductible: The amount you must pay for health services before your insurance starts to pay. Plans may offer you a lower copayment, but higher deductible, or vice versa. Considering your health needs for the upcoming year can help you choose which type of plan may work best for you, and where your costs come from.

Out-of-pocket maximum: The most you have to pay for health services. Once you have paid this amount, your insurance pays 100% of your remaining health care costs.

Prior authorization: Your health plan’s approval process before you receive services, which lets a provider know if the health plan will cover a needed service. Prior authorizations can be required on medications, services and treatments. Checking what might require prior authorization will help you avoid delayed care in the future.

Beyond considering the terms above, it is important you compare various plans that could be right for you, especially if you are considering switching plans. Some questions to consider:

  • Is my doctor in my plan’s network?
  • Is there a specific hospital I must use?
  • Are my drugs on a high $ tier? How much will that cost?
  • Does my plan have a copay accumulator adjustment program?
  • Does my plan cover home health care?

These are just a few questions to consider before committing to a plan. For a more comprehensive glossary and list of questions visit mypatientrights.org/checklist. You can download and print this resource so you can be sure you’re ready for the coming year. As part of Choose Smart California, My Patient Rights is here to help during Open Enrollment!

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State and federal law protects your rights. When you sign up for a health plan and/or if you have problems accessing care through your health plan, it is important to know your rights.