With so many changes in health care, it pays to know your plan

Hundreds of thousands of us enrolled in Covered California last year, and even more will enroll this year. For Medicare, thousands of Californians turn 65 every week and choose an Advantage plan, or a Medicare Supplement. With all of these new enrollees selecting new plans in Medicare and Covered CA, it means much more administration for the insurers. And that means more mistakes.

In a recent discussion with agents, major insurers pointed out that their clients (including the many new enrollees) have to take an active role in administering their coverage. With the significant amount of change that has taken place, we can no longer assume that all the insurance coverage we signed up for is doing exactly what it is supposed to do, or covering what we expect it to cover. As consumers, the burden has shifted to us to have basic knowledge of our health plan benefits.

At the very least, you should know the following:

What is the exact name of your insurance plan? The name of the insurer, the plan name, and level of coverage is all listed on your ID card. What type of plan is it? HMO, PPO, Advantage plan, Medigap F, N, G, etc. How much is your deductible? How much is your copay? Is there any coverage available before your deductible? Are you limited to one particular physicians’ group? Can you select your own specialists in network, or must you have a referral from your primary care physician?

The best way to gather this information is to sign up for access to your insurer’s website. Each insurer has a consumer website with a members’ section. By enrolling for access to their website, you will be able to track your medical expenses and the amount applied to your deductible, to see if your copays have been accounted for, to find specialists in your network, and even to estimate out-of-pocket costs for common procedures.

For example, if you are under age 65 and your doctor recommends a colonoscopy, you can login to your insurer’s website, pick a specialist to perform the procedure, and get a very accurate estimate of what your costs will be.

If you don’t have this information at hand, or can’t go online to retrieve it, call your insurer and ask for it to be sent to you. If you have a certified agent, they can answer these questions, as well as help you register online.

Take an active role in your health care plan. Know your costs to help avoid surprises and track usage to ensure you catch any errors before they cost you.

Randy Alan Foulds is a certified, independent health and life insurance agent in La Quinta. Foulds & Feldmann Insurance Agency can be reached
at (760) 777.9400.