Health care isn’t one size fits all and your health plan shouldn’t be either.
Choosing the wrong health plan can cost you more than just money—it can affect your care, your time, and your peace of mind.
Whether you’re managing chronic conditions, planning for fertility, or simply aiming to stay well, your health plan should reflect your unique needs. With so many terms and options, it’s easy to feel overwhelmed.
That’s why CalVEBA is here to help. Use these five tips to choose a plan that works for you and your family.
1. Know When and How to Enroll
Mark your Open Enrollment dates on your calendar now to avoid missing any crucial deadlines.
Missing your enrollment window could mean going without coverage or paying more than you need to.
Your employer’s Open Enrollment dates are unique. Please contact your Benefits Administrator for more information on your enrollment period to ensure you sign up for coverage within your window.
If enrolling through your employer, each organization will have a different process for where and how to enroll. Many streamline this process by making it available online. Again, this depends on your employer, but you can typically find this information through your HR representative.
2. Evaluate Your Current Health Care Needs
Since there’s no one-size-fits-all plan, it’s important to take inventory of what type of health care you need to feel your best.
This includes basic things like emergency and primary care coverage, but other services may also be important to you. When assessing your current needs ask yourself:
- Do I take certain medications regularly?
- Do I need access to mental health care?
- Do I need comprehensive reproductive health coverage?
- Do I see alternative practitioners covered by insurance like acupuncturists or chiropractors?
- Do I need dental or vision coverage?
It can be helpful to review the types of care you’ve used most over the past couple of years to identify your top priorities. While health care needs can change, it’s important to be mindful of which ones tend to stay the most consistent for you.
Also, make sure the plan you choose covers the 10 essential health benefits outlined by the Affordable Care Act (ACA). These benefits include:
- Ambulatory patient services (outpatient care without hospital admission)
- Emergency services
- Hospitalization (including surgery or overnight stays)
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices (these help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (note: adult dental and vision coverage aren’t essential health benefits)
Be cautious of plans that seem too good to be true. While they may offer lower monthly premiums, they often don’t cover these essential benefits and may come with high out-of-pocket costs.
3. Consider Your Future Health Care Needs
Planning ahead helps you avoid unexpected costs and ensures your plan grows with you. Your health care plan shouldn’t just account for your current health care needs, it also needs to be able to cover you for future ones. Future health care needs include ones you may or may not anticipate or be planning.
These are just a few potential changes to consider when looking at health care plans:
- Fertility planning
- Changes in medications
- Age-related screenings like colonoscopies or mammograms
- Unexpected accidents or illnesses
While you can’t predict the future, choosing a plan that offers flexibility and comprehensive coverage can help you stay prepared, so you’re not caught off guard when life happens.
4. Compare Estimated Yearly Costs
When reviewing health care plans, many people focus only on monthly premiums. While this approach can work for some people who are young and relatively healthy, it can also backfire. If your health needs change or you face an emergency, a low-premium plan could lead to unexpectedly high out-of-pocket costs.
To get a clearer picture of your total health care spending, consider more than just the premium. Look at each plan’s deductibles and copays to estimate your potential annual costs.
Your total yearly costs for the year typically include:
- Monthly premium x 12 months: The amount you pay each month to maintain coverage.
- Deductible: How much you must spend for covered health services before your insurance company pays anything (except free preventive services).
- Copayments and coinsurance: Payments you make to your health care provider each time you get care, like $20 for a doctor’s visit or 30% of hospital charges.
- Out-of-pocket maximum: The most you have to spend for covered services in a year. After you reach this amount, the insurance company pays 100% for covered services.
- Health and drug services you’ll use: Determine the health services and prescription drugs your household usually gets. Then, estimate the services you’ll likely use in the year ahead.
Yearly costs can also work the other way around. It’s important to find out how much your employer covers and any other health care subsidies you may be eligible for that can help reduce your overall annual costs.
5. Always Review Plan Options
Even if you love your current plan, reviewing your options each year ensures you’re still getting the best value and coverage. Looking at health care plans, crunching numbers, and thinking through your health care needs can feel overwhelming. But don’t skip this step or rely solely on automatic re-enrollment. While it may be tempting to avoid reviewing your options altogether, it’s important to review your options yearly.
You might assume there’s no need to review your options if everything else has stayed the same-your income, job, household size, and health needs.
However, many changes can affect your health care plan each year, even if they don’t directly involve you. For example:
- New insurers may enter the marketplace
- Premiums may change based on your location
- Coverage options may shift or expand
These factors can impact both the availability and cost of your plan. That’s why it’s essential to take a fresh look each year.
Open Enrollment only comes once a year—make the most of it. By following these steps and seeking the right guidance, you can find the best health care plan for you and your family.
If you find this blog helpful, check out the other blogs in our Open Enrollment series for more in-depth information here.
CalVEBA Resources
MyVEBA Portal
Use the MyVEBA app or online portal for your benefits information and updates. Download the app for Apple or Android, or visit the MyVEBA Portal for desktop access.
Benefit Contacts
For assistance with specific carrier benefits or issues, such as claims or coverage details, visit VebaOnline.com/Benefit-Contacts/.
Get Support
The California Schools VEBA Advocacy Team is here to assist with health care navigation, including appointment scheduling and quality of care. Call 888-276-0250 or visit VEBAOnline.com/Contact for assistance. For urgent requests, use the “Urgent” box on the contact form.
