Dr. Wendy Bernatavicius
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By Dr. Wendy Bernatavicius | Phoenix Children’s
As open enrollment season begins, families across Arizona face the annual challenge of selecting a health plan. With rising insurance costs and many plans to choose from, it can be daunting to find one that offers both affordability and the right coverage for everyone in your household. As a pediatric physician, I’ve seen firsthand how selecting the right health insurance impacts a family’s access to care — not to mention their peace of mind.
Why health plan selection matters
Choosing a health insurance plan isn’t just about finding the lowest premium. When evaluating options, it’s crucial to consider the specific health needs of every family member. Conditions like ADHD, asthma and even diabetes are becoming more prevalent among children, while adults may face their own health issues like hypertension or depression.
Whether managing ongoing care or preparing for unforeseen health events, families should take a careful and diligent approach to finding a plan that meets their needs.
Top considerations for picking a plan
Based on my experience, here are some key considerations to guide you through the decision-making process:
• Verify provider networks: Many of us rely on trusted primary care physicians and specialists, but insurance networks can change from year to year. Before selecting a plan, confirm that your family’s doctors and preferred hospitals are in-network to avoid higher out-of-network costs.
• Be cautious with narrow networks: Some plans offer lower monthly premiums, but limit coverage to a narrow network of providers. While these plans may seem cost-effective on the surface, they can lead to substantial expenses if a family member needs specialist care outside the network. This type of coverage may work for some, but narrow network plans can be risky for families managing chronic conditions or those who face an unexpected illness or injury.
• Review marketplace options: In 2024, Arizona’s Health Insurance Marketplace includes eight participating insurers, with one insurer providing coverage statewide while the others offer coverage in specific counties. The marketplace allows you to compare plans from several providers; it also underscores the importance of understanding each plan's network, coverage areas and associated costs to ensure it meets your family’s needs. Open enrollment for these plans runs from Nov. 1, 2024, to Jan. 15, 2025.
• Calculate the true cost of care: Low premiums can be attractive, but consider the entire cost of care, including co-pays, deductibles and co-insurance. If you anticipate frequent doctor visits or ongoing treatments, a plan with a higher premium and more comprehensive coverage might save you money over time.
• Look for extra benefits: Many plans include options for Health Savings Accounts (HSAs) or Flexible Savings Accounts (FSAs), which allow you to set aside pre-tax dollars for healthcare expenses. Some plans also offer wellness benefits, such as fitness program discounts or care coordination services, which can be valuable for families focused on overall health.
• Ask questions: If you’re unsure about any aspect of a plan, reach out to your insurance provider or human resources manager. Taking the time to understand what’s covered — and what isn’t — will help you avoid surprise expenses down the road and give you peace of mind.
Take control of your family’s health
Choosing a health insurance plan is one of the most important decisions you’ll make this year. By considering the specific health needs of your entire family and carefully evaluating your options, you can find a plan that balances affordability with quality care.
Remember, the right plan will help you not only manage costs but also access the services you need to keep your family healthy and thriving.
Editor’s note: Dr. Wendy Bernatavicius is the division chief of primary, complex and adolescent medicine at Phoenix Children’s. She is board-certified in general pediatrics as well as hospice and palliative care medicine. Reader reactions, pro or con, are welcomed at AzOpinions@iniusa.org.
