How to Prepare for Open Enrollment

Open enrollment is underway, giving families a chance to review their health coverage and choose a plan that best fits their needs. Among the many factors to consider, comprehensive pediatric coverage is an important part of choosing the right plan for your family. A single injury could require multiple doctor visits, outpatient surgery or physical therapy. Conditions such as allergies, behavioral health concerns or developmental delays may require ongoing medications, therapies and specialist care. Without a plan that provides comprehensive pediatric coverage, these expenses can add up.

It takes time to sift through complex coverage structures, insurance terminology and provider networks. These key considerations can make the process clearer and help you choose the right plan for your family.

Look Beyond the Monthly Premium
Monthly premiums are an important factor, but they are only one part of the overall cost of health coverage. Looking at the full picture can help you choose a plan that best supports your family’s health care needs and budget. Plans with lower premiums may have higher deductibles, copays or coinsurance, as well as more limited provider networks.

Before selecting a plan, compare what your costs could look like under different care scenarios, including doctor visits, medications or a hospital stay. Pay particular attention to the plan’s annual out-of-pocket maximum and its coverage for services received outside the provider network.

Out-of-network care typically costs more, and the amount an insurance plan will cover can vary. Understanding these benefits before your child needs care can help you feel more confident in your family’s plan and make informed decisions. This is especially important for families managing chronic pediatric conditions such as asthma, ADHD or diabetes. Depending on your family’s health care needs, paying a higher monthly premium for a plan with lower deductibles, copays or coinsurance could ultimately be more cost-effective.

Review Your Plan’s Provider Networks, Hospital and Clinic Access and Prescription Drug Coverage         
Make sure your child’s pediatrician and any specialists they see are included in the plan’s network. Confirm that your preferred hospitals and pediatric specialty clinics are in-network as well. For Arizona families, inclusion of Phoenix Children’s and providers in the Phoenix Children’s Care Network (PCCN) is particularly important. PCCN encompasses more than 1,400 pediatric providers across many subspecialties, connecting young patients with the care they need, from routine checkups to specialty services.

Remember to review the prescription benefits, also known as formulary, carefully, ensuring maintenance and emergency medications are covered. This is especially important for families managing chronic conditions that require ongoing prescriptions.

Consider Tax-Advantaged Accounts and Added Benefits
Some health plans offer additional benefits that can help support your family’s health and wellbeing beyond traditional medical coverage.

As you compare options, look for tax-advantaged options such as Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs), as well as wellness programs and care coordination services. These benefits can provide valuable support throughout the year.

Choose the Plan That Fits Your Family
The best way to approach open enrollment is to take the time to understand your family’s current health care needs while also preparing for the unexpected. Look beyond the monthly premium and consider the full picture, including provider networks, hospital access, prescription coverage, deductibles, out-of-pocket costs and additional benefits.

While every family’s needs are unique, taking the time to carefully compare your options during open enrollment can help ensure your children have access to the care they need when they need it most. Ultimately, the right plan is one that provides both access to quality pediatric care and greater peace of mind for your family.

Timur Ozhan Raghib, MD, FAAP, is a pediatric hospitalist and director of medical services for Phoenix Children’s East and West Valley campuses. Dr. Raghib earned his medical degree from the University of North Dakota School of Medicine & Health Sciences.