As open enrollment season rolls around, Arizona families are faced with one of the most significant decisions they’ll make all year: selecting a health insurance plan. Amid increasing costs and complex factors to consider, making the right decision can feel overwhelming. To help you navigate this process, here are things to keep in mind as you’re choosing a health plan for your family in 2024.
The Importance of Finding the Right Fit
When you have children at home, choosing a health plan is about more than just picking an affordable premium. With conditions like ADHD and asthma becoming more prevalent, families should evaluate their health insurance options carefully to ensure they have adequate coverage for these and other common health concerns—including any doctor visits, medications and specialist care or therapy that might be needed.
Taking the time to understand exactly what is—and isn’t—included in a plan is essential; some options offer comprehensive benefits, while others provide only limited coverage, which can lead to substantially higher out-of-pocket expenses.
In addition to managing ongoing health conditions, it’s also important to consider how a health plan handles acute, one-time issues. For instance, if a child or teen suffers a sports injury like a torn ACL, they may need a combination of specialist care, imaging, outpatient surgery and physical therapy. The right coverage can make a substantial difference in managing the associated costs.
By making informed decisions now, you can be prepared for a variety of medical situations—whether chronic or temporary—and ensure your family has access to the right care when it’s needed most.
Factors to Consider When Choosing a Health Plan
1. Double-Check Your Network: Before committing to a health plan, verify that your family’s pediatrician, primary care physician and any specialists are included in the network. Contact your providers to confirm they accept the plan you’re considering. You’ll also want to take the time to ensure your preferred hospitals and clinics are included in the network.
2. Review Prescription Drug Coverage Carefully: Medication costs can be a big factor for families, especially when managing a chronic condition. Make sure the plan you select includes coverage for your family’s essential medications—whether it’s maintenance medicine or emergency treatments.
3. Understand Out-of-Network Limitations: Some health plans provide limited out-of-network coverage, which can leave you paying a significant portion of the bill if you need a specialist outside the approved network. Consider whether the plan offers sufficient out-of-network benefits for your family’s specific needs.
4. Look Beyond Premiums to the True Cost of Care: Plans with low premiums often come with higher deductibles and co-pays. While lower monthly premiums may seem appealing at first glance, the other expenses can add up over time. Calculate total costs—including co-pays, deductibles and co-insurance—to make a more informed choice.
5. Be Aware of Plans with Limited Networks: Plans with restricted networks may save on premiums but can lead to higher costs if you need specialist care. If a family member may need care outside a narrow network, carefully weigh these potential expenses before selecting a plan.
6. Get to Know the Marketplace Options: Marketplace plans come with restrictions, so confirm that your providers are in-network and that the coverage aligns with your family’s anticipated healthcare needs. Take the time to research and compare these options to find the best fit.
7. Consider Extra Benefits That Add Value: Many plans offer additional perks like health savings accounts (HSAs) or flexible savings accounts (FSAs), which allow for tax-free healthcare spending. Consider plans that also provide care coordination services or wellness benefits that could provide extra support for your family.
Get the Clarification You Need
Don’t hesitate to contact your human resources director or insurance representative with any questions or to get the clarification you need. With the right preparation, you can find a plan that provides peace of mind and access to the quality care your family needs and deserves.
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Karen Sanchez is Director of Family Finance at Phoenix Children’s, where she helps patient families understand their insurance benefits, makes special payment arrangements when needed, and ensures children can access the care they need. She also oversees a team of financial counselors who work to connect children with necessary medical services, regardless of their ability to pay. Sanchez has served Phoenix Children’s families for more than 14 years. She holds a bachelor’s degree in business administration and management and a master’s in healthcare administration.
