Choosing the Right Health Insurance Plan

As the Health Insurance Marketplace transitions to plans with higher deductibles, patients are facing more financial responsibility than they ever have in the past. This makes understanding your plan options and benefits extremely important, so we sat down with Women’s Care’s Practice Administrator, Tasha Frahm, to learn more about what changes patients can expect and get her advice on how to choose the best plan.

Changes in the Health Insurance Marketplace

If you’re getting your insurance from the Health Insurance Marketplace—also known as Obamacare or the Insurance Exchange—there are a few key changes to look out for this year.
“There are going to be a couple of really big players that are going to stop having programs on the Marketplace,” Tasha explains. Two of the largest insurance companies that will be leaving the Marketplace are Anthem and Molina.
For those of you living in our service area, that leaves Network Health Plan and Common Ground Health Cooperative.
“Women’s Care doesn’t currently have a contract with Network Health Plan, but we are actively pursuing a contract with Common Ground Health Cooperative,” Tasha says. “I feel very confident that we will be able to make that happen, but if patients see a Women’s Care provider and they want to continue to see a Women’s Care provider, Common Ground Health Cooperative is going to be their best bet.”

Health Insurance Changes for State Employees

If you’re a state employee, your plan options may be limited this year.
“State employees typically fall into the Employee Trust Fund,” Tasha explains. “Historically, they have had upwards of seven different insurance options. This year, it looks like they are going to scale back quite a bit.”
While statewide, Wisconsin employees may still have up to seven options, employees in our market will only have three insurance plans to choose from.
Those plans are Security Health Plan, WEA Trust, and Network Health Plan.
“If you’re a state employee who sees a Women’s Care provider or would like to see a Women’s Care provider, it’s important to remember that we don’t have a contract with Network Health Plan,” Tasha points out. “But we do have contracts with Security Health Plan and WEA Trust.”

Why the Sudden Health Insurance Changes

While this is a drastic change compared to previous years, it’s not atypical to see a lot of change in the Marketplace within one year.
“Employers change year after year, and every year they change the health insurance plans they offer,” Tasha says. “It just so happens that the state of Wisconsin employee population is so large that when the state makes a change, it affects a lot more people than when another company makes a change.”
In other words, it may seem like state of Wisconsin employees are being affected the most by these changes because they are being affected on such a large scale.

What Should Women Consider When Choosing Their Plan?

• Provider: If you are seeing a provider that you would like to continue seeing in the future, make sure that provider is covered by your new health insurance plan. If you are currently seeing a provider at Women’s Care, we suggest looking into Common Ground Health Cooperative, Security Health Plan, or WEA Trust.
  
• Benefits: Make sure you really understand the benefits of the plan you’re considering, particularly preventative care benefits and the benefits that are important to you and your family. Pay attention to what you’re paying out of pocket, if there’s a limit to what you’re paying out of pocket, and what you’re responsible for.
  
• Deductible: As we start seeing plans with higher deductibles, it’s extremely important for patients to understand what happens after their deductible is met. Is there more money you still have to pay? If so, how much and until what amount?
  
• Fertility Treatment / Pregnancy: If you’re looking into fertility treatments or if you may become pregnant, we really encourage you to pay close attention to those specific benefits for each plan. Fertility is tricky because some insurance plans will cover a portion of it, while others won’t cover any of it. Choose the plan that’s right for you to avoid paying out of pocket later on.​
  
• Birth Control: If you have a preferred birth control method, figure out how it’s going to be covered by your new health insurance plan and understand exactly what your benefits will be for the next year. Our government is changing, and insurance companies will follow suit in the near future, so this is a very important area for women to consider!

​Choose What’s Right for You

With all of the health insurance changes taking place this year, it’s crucial to research your options and take the time to understand everything that’s available to you.
“Don’t be afraid to reach out to different health insurance companies and ask questions before you select your plan and also afterwards,” Tasha encourages. “Understand what your coverage is so that you’re not surprised when you get your next medical bill. I hate to see patients who are surprised because they thought something was covered and it wasn’t. No one ever wants to be in that position.”
For state employees, enrollment has already started and will close on October 27th, so be sure to get your research done so you can choose your plan soon!
As for everyone else, open enrollment is scheduled to begin on November 1st and end on December 15th. It’s important to note that this year’s enrollment period is shorter than it has been in the past. Originally, open enrollment was scheduled to run through January 31st. However, the DHS’s proposal to cut the duration of the enrollment period in half was approved, so be sure to enroll early!