Ep. 92: Navigating Open Enrollment for Health Insurance: Choosing the Right Plan
Part of the series: Allergy, Asthma & Immunology Innovations Podcast
This podcast was made in partnership with Allergy & Asthma Network and in collaboration with the National Association of Medication Access and Patient Advocacy (NAMAPA).
We thank Amgen for sponsoring this episode. While they support the show, all opinions are our own, and sponsorship doesn’t influence our content or editorial decisions. Any mention of brands is for informational purposes and not an endorsement.
LISTEN TO EPISODE 92:
It's that time of year again—open enrollment is here! Don't worry, we're here to help you choose the best health insurance for you and your family.
Lacey Varnon from the National Association of Medication Access and Patient Advocacy (NAMAPA) is back with Dr. Gupta and Kortney to discuss everything you need to consider when selecting a health insurance plan. This episode is all about understanding health insurance during open enrollment, from picking the right type of plan to ensuring your coverage fits your specific needs.
We cover essential aspects of open enrollment health insurance, including networks, premiums, copayments, and long-term medication coverage, so you can feel confident you're choosing a plan that works for you.
What we cover in this episode about health insurance open enrollment:
Key Factors to Consider: Lacey explains the importance of listing your doctors, diagnoses, and medications to ensure they're covered.
Understanding Premiums, Deductibles, and Networks: Gain insight into how these elements impact your out-of-pocket costs and access to care.
Plan Types – HMO, PPO, EPO, and POS: We break down each type of plan, including pros and cons, to help you decide which suits your healthcare needs.
Special Considerations for Pharmacy Benefits and Long-Term Medications: Lacey offers advice on accessing necessary medications through your health plan or alternative methods if they are not covered.
Navigating Open Enrollment with Family Needs in Mind: Tips on choosing a plan that considers your family member's medical needs and how you've used insurance in the past.
About our open enrollment expert - Lacey Varnon
Lacey Varnon, ADN, PACS, BCPA, is the vice president of NAMAPA. She is an expert in navigating health insurance and is dedicated to helping patients and providers work through the complexities of medication access and healthcare. With her experience at NAMAPA, Lacey's insights are invaluable for those facing the challenges of understanding health insurance and choosing the right plan.
More resources about health insurance:
More Episodes About Health Insurance
Understanding the Different Insurance Plans
HMO (Health Maintenance Organization): HMO plans require members to choose a primary care physician (PCP) and get referrals to see specialists. They typically have lower costs but require you to stay within a network. Best for individuals who prefer coordinated care and lower out-of-pocket costs.
PPO (Preferred Provider Organization): PPO plans offer more flexibility, allowing you to see any doctor without a referral, even out-of-network, though at a higher cost. Ideal for people who want more freedom in choosing providers and don't mind paying more for that flexibility.
EPO (Exclusive Provider Organization): EPO plans combine aspects of HMOs and PPOs. You don't need referrals to see specialists, but you must use in-network providers (except for emergencies). This plan suits those looking for some flexibility with generally lower premiums than PPOs.
POS (Point of Service): POS plans require a primary care doctor (PCP) and referrals for specialists, but they offer out-of-network coverage at a higher cost. This plan works well for people who want a PCP to manage care but still want some out-of-network options.
High Deductible Health Plan (HDHP): HDHPs have higher deductibles but lower premiums and often pair with Health Savings Accounts (HSAs). They work well for healthy individuals who don't expect frequent medical expenses and want to save tax-free for future healthcare costs.
Timestamps
How to choose the right health insurance plan
01:43 Lacey’s Introduction & NAMAPA Overview
02:12 Key Consideration When Choosing Insurance
06:05 Essentials for Your Plan: Doctors, Diagnoses, Medications
07:20 Understanding Premiums and Deductibles
10:55 Exploring Insurance Networks
12:16 Copayments Explained
13:05 Pharmacy Benefits & Long-Term Medication Coverage
16:19 Understanding HMO (Health Maintenance Organization) Plans
20:02 PPO (Preferred Provider Organization) Plans
22:13 EPO (Exclusive Provider Organization) Plans
23:48 POS (Point of Service) Insurance Plans
26:08 High Deductible Health Plans
28:25 Insurance Through a Spouse’s Plan
29:52 Coinsurance Basics
32:32 Using HSA and FSA Accounts
37:56 Out-of-Pocket Maximums
39:03 Tips for Navigating Open Enrollment
41:48 Considering Family Needs in Plan Selection
43:19 Reviewing Last Year’s Insurance Usage
