What Should I Ask When Seeking a Plan?

The Affordable Care Act gives everyone more choices when shopping for a health plan. It allows you to compare and shop for health coverage that meets your needs and fits your budget, whether you purchase directly through Blue Cross and Blue Shield of Texas, the Marketplace or a licensed insurance agent.

Open Enrollment for health insurance begins on Nov. 1 and runs through Dec. 15. During this time, you’ll need to decide if you’re going to apply for a new individual or family plan, keep your current plan or pick a new one.  A new Special Enrollment Period is taking place from February 15, 2021 to May 15, 2021, you can apply for a 2021 BCBSTX Individual health plan for yourself or your family. Of course, as with any big purchase, like a car or a TV, there are a few things you should do to prepare before buying. As your search for health insurance coverage begins, ask yourself:

What provider network does the plan use?

• Is your doctor in the plan’s network?
• Have you checked to see if your doctor, specialists, hospitals or urgent care centers are in the plan’s network that you selected? You can use the BCBSTX Provider Finder to check.

How often do you visit the doctor?

• Do you only get sick a few times per year?
• Do you have a health condition that means frequent visits to the doctor or hospital?
• Are you thinking about having a child?

Do you take prescription drugs?

• Can you take a generic drug, or do you take name-brand drugs that may cost you more each month? Drug coverage may differ by plan. You can see the formulary, or drug lists, for each plan we offer as well.
• Note what the drug deductibles and copays are for each plan. If you take a lot of medicine for a health issue, you may be better off paying a slightly higher monthly premium to have lower drug costs.

How much can you spend?

• Every plan is different, so before shopping, set a budget. How much will you be able to spend every month? Think about the monthly premium, but also keep in mind the deductible, copayments and other out-of-pocket costs to figure out what you could end up paying within a year, should you have unexpected medical bills.
• If you think you may be able to get financial assistance, use our subsidy calculator to check. You may qualify for a plan with a low premium.

Do you need dental coverage?

• Some plans include dental coverage or you can buy a separate dental plan. 
• If you know you will need a lot of dental work next year, such as an implant or kid’s braces, you may want to add a Health Spending Account to cover out-of-pocket costs.

What do the plans look like?

• There are many plans to choose from that can meet your needs and budget.
• Visit the Shop Plans page on our website to learn more and shop for a plan that’s just right for you.

Now that you know the questions to ask yourself, do you have any questions for us? Call us at 888-731-0383 or log in and ask below!

Original publish December 3, 2014; Revised 2015-2020