Tips for Choosing a Plan

When you have more than one plan to pick from, it can be hard to know which one to choose. Plus, you may have the option of choosing your plan benefits (how health care services are covered) and your provider network (the health care providers you’ll see when you need care). The information on this site shows which options are available to you. The following can help as you weigh your choices.

Choosing your provider network 

A provider network is a group of doctors, hospitals and other health care providers contracted to provide services to Medica members for less than their usual fees. You receive your highest level of benefits when you see providers in your plan’s network. Your network options are described on the following page(s).

If you have a choice of networks, consider the following:

  • Is it important to keep your current doctor?
    Check each plan’s network to see whether your doctor, hospital and other health care providers are included. Be sure to choose a network that meets the needs of your entire family, since you’ll all share the same network.
  • Do you need to see specialists?
    With some networks, you’ll need a referral to see a specialist in certain cases (for example, in a care system network, when you want to see a provider outside of your care system). Other networks don’t require a referral as long as you stay in the network. Check the plan’s details and Summary of Benefits and Coverage, found on the Plan Options pages, to learn whether you need a referral.
  • What size network do you need?
    Plans with a smaller network generally have lower premiums. Accountable Care Organizations (ACOs) have a more focused network, but offer added features and support, usually at a lower cost. If an ACO is one of your options, and you and your family already see providers in that ACO, then this type of network might be right for you. If it’s important to have access to a wider range of doctors and other providers, a larger network might be a better fit.

Choosing your plan benefits

Your plan benefits determine how things are covered and what your share of the costs will be. For example, whether the plan has a deductible and/or coinsurance. To see what a plan covers, check the plan’s Summary of Benefits and Coverage, available on the Plan Options pages on this site.

If you have a choice of benefits, consider the following:

  • Would you rather pay your costs up front, or as you go?
    Plans with more coverage usually have higher premiums (the set amount you pay for your coverage), but offer lower costs when you receive care. Plans with lower premiums usually have higher deductibles and other out-of-pocket expenses, meaning you’ll pay more as you receive care.
  • Are you expecting a lot of health care expenses this year?
    Compare each plan’s out-of-pocket expenses (the deductible, coinsurance, out-of-pocket maximum, etc.) to see which plan best fits your situation. To get an idea of your overall cost, be sure to also factor in your premiums.
  • What if you get seriously ill?
    Could you afford to pay the plan’s out-of-pocket maximum (or limit)? This amount is the most you would pay for covered services in a year. After that, your plan pays 100%. Keep in mind that a plan may have an individual and a family limit, and separate limits for in- versus out-of-network care.

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