How to shop for health plans during Obamacare open enrollment

Healthcare Watch
Diana Newton, 31, has a rare form of rheumatoid arthritis, and it was crucial that her health plan covered the two doctors she relies on most for care.
(Mel Melcon, Los Angeles Times)

Starting this weekend, anyone interested in changing an existing health insurance policy or buying a new one can do so during the second open enrollment period under Obamacare.

Those interested in having a plan in place by Jan. 1 must make their selection by Dec. 15. And the final deadline is Feb. 15.

Diana Newton, 31, shopped Covered California for health insurance last year for her and her husband.

“We signed up for a plan and thought it was pretty reasonable, and it had both of my doctors in my network,” says the Pilates studio owner from Los Angeles.


With a rare form of rheumatoid arthritis, it was crucial Newton’s health plan covered the two doctors she relies on most for care. All looked good with her new policy … until it didn’t.

“When I went back for my second visit in February they stopped me at the door and told me, ‘Sorry, you can’t have a visit. We’ve dropped out of your network. And by the way, you have an outstanding bill [of $1,800] from your visit in January,’” she says.

Like Newton, many consumers have complained this year about confusion over their provider network, unforeseen medical bills and other challenges with their new policies. In a rush to sign up for coverage, many simply missed the fact that doctors, big health systems or medications they needed were not included in the plans they selected.

Now millions of Californians have an opportunity to switch to a plan that better meets their needs, re-up with their existing plan, or pick one for 2015 if they missed open enrollment the first time around.


Experts offer shopping recommendations for open enrollment.

Watch for changes. Because benefits and prices change each year, it’s important for everyone to review their plan options for 2015, says JoAnn Volk, senior research fellow with the Georgetown University Health Policy Institute.

“Even if you’re happy with your plan it may not be the same for next year,” she says.

Go back to make sure that your plan hasn’t changed the amount you’ll pay in premiums and out-of-pocket costs, and that it still meets your healthcare needs.

Some plans that were in place this year won’t be offered in 2015. If your plan is affected, you should have already received notice from Covered California. Take action and sign up for a new plan or you’ll be without coverage Jan. 1.

“The thing is to not ignore the letter and to figure out what you need to do and see what’s available,” says Patrick Burns, president of the California Assn. of Health Underwriters.

Check your eligibility. This year, more than 1 million Californians received federal subsidies to help pay for medical coverage. If you’re among them, be aware that any changes to your income or household size — such as a new baby or divorce — need to be reported to the exchange.

You may be entitled to more help than you’re getting if your income is lower than anticipated. On the other hand, if your income was higher than you initially reported, you could be getting too much financial help.


“Come April 15, if you understated your income, then you may have to pay money back on your taxes because you didn’t qualify for all the subsidy that you said you would qualify for. That is going to be a possible area of concern for a lot of folks,” Burns says.

Double-checking income. If you applied for insurance through Covered California last year, you were asked for consent for up to five years to have your income confirmed with the Internal Revenue Service and other sources. If you said yes, and you still qualify, your coverage will be automatically renewed, along with the appropriate subsidy, says James Scullary, spokesman for Covered California.

However, if you declined, you’ll have to go back into the system to complete a renewal packet for 2015; otherwise, even though your plan will be automatically renewed, your financial assistance will be cut off. You’ll be billed for the full cost of your insurance premium.

Covered California will send notice about your plan renewal and whether you’ll continue to receive financial help, and how much, Scullary says.

Networks: Check and check again. Generally, plans sold on the exchange will continue to offer limited provider networks with access to fewer doctors and hospitals.

On the upside, says Carolina Coleman, research director with Insure the Uninsured Project in Santa Monica, “Narrower networks generally are going to be cheaper.”

The key, she says, is to understand the trade-offs between lower premiums and more choice, and how your plan’s provider network will affect your costs and access to medical care.

“If you care very strongly about a particular provider, you have to triple check” that he or she is in your plan’s network, Coleman says. That means reviewing the provider directory on each health plan’s website, and calling both the insurance company and the provider directly to confirm participation.


And don’t forget to carefully check the list of pharmacies and drugs each plan covers. If you take a lot of medications or require high-priced specialty drugs, you may save in the long run by buying a Gold or Platinum-level plan that covers more out-of-pocket costs when you go to fill prescriptions.

Help is available. Covered California will have about 1,300 service center representatives to help you renew or select a plan when open enrollment starts Nov. 15. You can reach one by calling (800) 300-1506.

You can also work with a certified enrollment counselor or insurance agent. Go to and click “Find Help Near You.”

Newton, who owns the Pilates studio, was able to change policies before open enrollment closed this year to one that covered her doctors. She says she knows shopping her options for next year is a good idea. But after last year’s experience, she’s hesitant.

“I want to look, but I’m very scared,” she says.

Her curiosity may win out, though. “I would love to know if there’s something better for me out there.”

Zamosky is the author of “Healthcare, Insurance, and You: The Savvy Consumer’s Guide.”

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