With the loss of the individual and family PPO health insurance networks coming in 2018, and those who are under the age of 65 and buying their own health insurance, making sure your doctors are in your health insurance plan network matters more than ever.  The plans in our area that are going to be offered are of the HMO, EPO, or other type of networks.  This means that you will not have the freedom to get your non-emergent care out of network, go anyplace you want, and many plans require you have a referral from your Primary Care Physician.

Here is what we recommend you do to prepare yourself for this change:

  • Make a list of the doctors, clinics, and hospitals that you are seeing or want to see if something were to happen to your health.
  • Make a list of the Rx you are currently being prescribed.
  • Talk to your doctors and ask them who they are contracted with, or dropping their contract with for 2018, or simply don’t like to deal with.

Advise your broker of this info and have them research what networks hopefully have everyone and everyplace in network.  Keep in mind that your broker will not be able to research this until Open Enrollment begins AND that the networks can change.  The change can occur for many reasons – the facility and health insurance carrier cannot come to an agreement or the facility purchases another clinic/facility and the network changes, etc.

We had a client who chose a plan that his doctor was in network with the carrier.  When the client went to visit the doctor, the doctor advised him that if he had a choice between the health insurance company he chose and the plague, he should have picked the plague.

The individual and family health insurance market open enrollment begins on November 1st, 2017.  This is the time for you to make your health insurance plan selection for 2018.