California goal: Protect health care coverage

A vaccination in progress. (Photo: Komsan Loonprom)

Many families across California are feeling anxious about the future of their healthcare coverage. The campaign promise by president-elect Donald Trump to repeal Obamacare has likely created unease among many of the approximately 1.5 million Californians who purchase insurance through Covered California—the state’s online healthcare marketplace. Even for those who receive coverage through their employer or Medicare, the incoming administration’s approach to healthcare remains largely unknown.

Within what may seem to be an uncertain landscape, it is important to remember that health coverage is still available to Californians for next year. The current open-enrollment period is an opportunity to secure insurance for oneself and one’s family, and to help make health care coverage in 2017 a certainty.

Don’t forget to check the details of prescription coverage in your plan. When people think about health insurance, they often think first and foremost about doctors and specialists. But healthcare also means coverage for medications.

Open enrollment—the period when any individual can purchase or make changes to their health insurance—began on November 1 and runs until January 31, 2017. Individuals who shop for health care on their own have until Dec. 15 to purchase coverage that starts on the first day of the new year. Even though the current open-enrollment period coincides with what is a time of political transition, now is the time to take a clear-headed approach to one’s healthcare needs. Now is the time to take a step back and take stock of medical priorities so that you can choose the health insurance plan that is the best fit for you and your family.

Here are a few things to keep in mind when looking for healthcare coverage for 2017.

Take a few moments to check the coverage network of your current plan or any new plan you are considering. Double-checking the network is important because even though a doctor may be in your plan’s network this year, it does not automatically mean he or she will be in the network next year. Whether you are purchasing insurance on your own or selecting from options through your employer, choosing a plan that covers your preferred doctor will prevent you from having to find a new physician or transfer any medical records to someone else.

Don’t forget to check the details of prescription coverage in your plan. When people think about health insurance, they often think first and foremost about doctors and specialists. But healthcare also means coverage for medications, so it is important to make sure that the medications you take are on the insurance’s list of pre-approved drugs. Choosing a plan that covers your regular medications can help keep down your family’s health care costs.

At the same time, all Californians should check the details of some lesser-known aspects of insurance coverage that can impact care: specifically, administrative insurance practices such prior authorization requirements, step therapy policies, and the policy on continuity of care. Prior authorization requires physicians to obtain the insurance company’s approval before the insurance will pay for certain medications or treatments. Step therapy policies – often called “fail first” – require patients to try and fail on older, cheaper alternatives before the insurer will cover the treatment that was originally prescribed by a physician. And, continuity of care means the insurance company cannot increase co-payments for prescription medicines in the middle of the year or change which medicines they will cover after a doctor has prescribed them.

The California Chronic Care Coalition will continue to fight for access to affordable, quality health care for all Californians, and we also urge all Californians to become advocates for their own care. Understanding a plan’s coverage details with regard to these policies may mean reading the fine print or speaking with the insurance company directly to clarify benefits. While doing so may take a little time, it can help people make the right choice about which plan to select and can reduce the chances of unintended healthcare costs down the road.

Choosing the right insurance is one of the most important decisions we make each year. It is worthwhile to take the time now to choose the proper coverage and create healthcare certainty for the coming year.

Ed’s Note: Liz Helms is the President and CEO of the California Chronic Care Coalition. For more information, visit www.specialtyrxsos.org

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