Health insurance guide for families

Open enrollment for the 2023 benefit year is now upon us, giving many people an opportunity to weigh their healthcare options for the year ahead. It’s not a simple process for anyone.

Those with employer-provided benefits are likely reviewing several health packages and noticing yet another increase in their share of the bill. Others may search healthcare.gov for the right plan for their families, but the health insurance marketplace presents its own batch of issues.

In Arizona, many of the major insurers have exited the marketplace, limiting options for locals.

To make matters worse, most insurance companies are posting double-digit rate increases, which hits the wallet hard. It’s all taking a toll on families’ budgets – especially amid increasing costs of living – and many of us are experiencing sticker shock at high co-pays, deductibles, coinsurance and premiums.

If you’re like most people, you may be tempted to choose your insurance with your pocketbook, but it’s important to weigh cost alongside quality of care, access to trusted physicians, and even proximity – especially if you or a member of your family has a complex or chronic condition.

If that’s the case, choosing medical coverage is one of the most important decisions you will make all year.

Doing your homework is vital. When choosing your health plan for 2023, follow these steps to ensure you pick the best plan for your family. Most importantly, remember you’ll have to live with your choice for an entire year, so take great care with this decision.

Make sure your provider is in-network. We often rely on trusted primary care physicians and, in many cases, dedicated specialists. Don’t take for granted that your doctors will be in-network, as insurance plans change every year. Make sure your providers accept the plan you’re considering.

Be wary of narrow networks. Among the health insurance products for sale are highly limited plans that offer lower premiums in exchange for extremely narrow provider networks.

Narrow networks are a fine solution for many people, but they can be disastrous for people who experience a serious injury, illness, or have complex or chronic health needs. In fact, despite a low sticker price, picking a narrow network may result in higher costs if a family member needs to see a specialist or receive treatment outside the network.

Do the math. Low premiums may be tempting but the cost of health care goes well beyond the monthly payment. Be sure to consider your share of the costs for doctor visits and medications, too.

For some families, particularly those requiring specialist care or ongoing medical treatment, it may be more cost-effective to purchase a plan with a higher monthly premium that covers a greater share of health care costs through a lower deductible, co-insurance or co-payment.

Consider the “extras.” Some plans have an option for a Health Savings Account (HSA) or Flexible Savings Account (FSA). You can fund these pre-tax accounts to cover healthcare-related expenses. Plans may also offer perks like Care Coordination Services and Healthy Lifestyle benefits, which may be important considerations in your decision-making process, too.

If you have questions, ask. Contact your broker, human resources manager or plan provider with questions about your plan. You can also call Phoenix Children’s Family Financial Services at 602- 933-2000. This free program helps families understand their coverage options and choose a plan that meets their needs. 

Emilia Gomez, MD, is a pediatrician at Pediatrics of Queen Creek, which is part of Phoenix Children’s Care Network, Arizona’s only pediatric network that includes more than 1,175 pediatric primary care providers and specialists as well as Phoenix Children’s Hospital. 