John Maszinski
Cell: 312-608-3620
Surviving Open Enrollment and Health Insurance Sign-Ups
Illinois doctors offer tips to patients when evaluating health plans

Chicago, IL - Open enrollment season is upon us. Whether you are purchasing insurance through the Affordable Care Act marketplace, reviewing your employer-based coverage or enrolling in Medicare/Medicaid, the Illinois State Medical Society (ISMS) urges Illinoisans to closely review coverage details and do your homework.

"Researching health insurance doesn't top anyone's list of fun projects," said ISMS President Scott Cooper, M.D. "Yet, it is critical that health care consumers pay attention to the details when enrolling in or renewing health coverage. A little work now can help you avoid a surprise bill or denial of coverage by your insurer."

When selecting a health insurance plan, ISMS urges patients to consider three simple questions:

Can I see my doctor? To cut costs, many health plans are narrowing the number of physicians and hospitals considered "in-network." Receiving care from an "out-of-network" hospital or physician usually requires additional payment by the patient. When enrolling in a plan, review the insurer's "provider directory" to make sure your doctor accepts the insurance and confirm participation with your physician's office. Also, look at the hospitals and health facilities covered by the plan. If you have a condition requiring specialty care, it is important that you make sure that doctor is in-network as well. Medicaid patients should also pay attention to which options are available to them, as the state is transitioning many Medicaid patients into a managed care program.

How much will I spend on health care? Consider that monthly premiums are only one component of your potential health care expenses. Most plans require that you pay a share of your care through "co-pays," out-of-pocket charges that you are personally responsible for at the doctor's office, hospital or pharmacy. Typically, health plans do not begin paying your medical expenses until an annual deductible is met. When comparing health plans, review the "annual out-of-pocket maximum" to see what your total expenses could reach.

Are my medications covered? If you take prescription medications, make sure they are included on your plan's "drug formulary." If it isn't clear, contact the plan directly to ask about your specific medications. Some plans pay for non-formulary medications when requested by your doctor, but this is not considered automatic.

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Founded in 1840, ISMS is a professional membership association representing Illinois physicians in all medical specialties, and their patients, statewide. Dr. Cooper is an emergency physician practicing in Waukegan.

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