Health plans vary in terms of out-of-pocket costs, freedom of choice of providers, and coverage of preventive services. Some offer fewer out-of-pocket costs, require no referrals, and let you choose a primary care physician. Others are more restrictive and require you to see a specialist. Care outside the network is usually more expensive. You can find a summary of health plan benefits from your employer or from an online marketplace.
Marketplaces are available in most states. Some states operate their own Marketplaces, while others use federally run websites. Marketplace plans are only available during the Open Enrollment Period (OEP). However, Medicaid and CHIP can be enrolled anytime. You can enroll in a Marketplace plan online, by phone, or by mailing a paper application. If you need help, a trained assister can help you complete the application.
Before purchasing a health plan, make sure you know your needs and goals. Determine how much coverage you need, how much you can afford to pay each month, and whether you want to have a preferred doctor. Also, look for a plan that will cover the services of many different doctors. Choose one that is in-network for the physicians and hospitals in your area.
You should also know your rights and responsibilities under ERISA. This federal law protects the interests of consumers when it comes to medical care. If you are covered by an ERISA-compliant health plan, you are covered by the plan’s rules.