How to Pick a Health Insurance Plan (or make the most of the one you have)

You may or may not have a choice regarding your health insurance plan, but that doesn’t mean you shouldn’t be well-informed about the choices you do have when it comes to one of the most important resources available to you and your family. Here are a few points you should know as you embark on choosing (or making the most of) your health insurance plan for 2017.

Making the Most of Your Employer-Sponsored Health Coverage

If you are employed, chances are your employer offers one or more health insurance plans to choose from. If you have a choice, you can use the guiding principles outlined in the next section to help determine the best option for you. If your employer offers one health insurance plan, there are many ways you can make the most of it:

• Enroll in a health funding account – Similar to saving for retirement, Americans also need to think about saving for their health care futures, which can be done by establishing a health funding account. Health funding accounts are a big topic of discussion right now, and for very good reason. As companies switch from traditional copay plans to high deductible health plans, employees are faced with more out-of-pocket spending. This is where funding accounts can help alleviate the burden. If your employer offers a health savings account (HSA), health reimbursement account (HRA), or flexible spending account (FSA), consider your options, and talk with your health benefits administrator about which funding account is right for you.

• Take advantage of plan enhancements – Some health plans, like CDPHP, recognize the steps members take for living healthy or making a commitment to improving their health. Wellness programs such the CDPHP Health Hub, powered by Virgin Pulse reward members for activities they are completing anyway, such as getting an annual physical, taking a CDPHP community wellness class, or tracking their fitness with activity trackers. Earn CDPHP Life Points® Rewards for these activities that can be redeemed for gift cards.

• Get help managing a chronic condition – Did you know that if you’re living with a chronic illness, such as cancer or COPD, there are likely helpful resources available through your health insurance plan that go beyond the doctor’s office? Coping with and managing a chronic disease can be challenging, both for you and your loved ones, but it doesn’t have to be. Talking with a supportive medical professional can ease your mind, and you’ll get tips for living your best life possible. At CDPHP, we offer support through our Care Teams.

Shopping for an Individual Health Plan

If you are shopping for health care coverage for yourself, a spouse, and/or dependents, there are several things to consider beyond premiums and out-of-pocket costs, though both are extremely important. Here are some other factors you should bear in mind:

• Drug benefit – The rising cost of prescription drugs has been a hot button issue for quite some time now. If you take medications regularly, you will want to be sure that your plan includes a drug benefit that meets your individual needs. Check out plans that offer discount programs, too, such as Rx for Less, which gives CDPHP members deep discounts on their generic prescription drug needs.

• Access to primary care providers (PCPs) – When you are sick, you want to see your doctor that day, not in the next few weeks, and you want these services to be affordable. If you select a CDPHP health plan, you may want to consider choosing a PCP that participates in our Enhanced Primacy Care (EPC) program, which can offer you more time with your doctor, better access, and the ability to communicate electronically.

• Network access – While traveling, or if you have a student away at college, you’ll want to consider your health plan’s reach, and the access you will have to doctors around the world.

• Company reputation – Have you spoken with friends or family members about their health care coverage? Are they happy with it? Before starting the shopping process, take a minute to talk with some trusted individuals about their experiences. Also, take into account social responsibility. Does the company invest in its community? Are earned dollars used to help those in need? CDPHP is proud to support the communities we serve.

Once you’ve considered the aforementioned items, your first stop in New York state is the New York State of Health™ Marketplace. You can visit the Marketplace online, or, feel free to call 1-855-355-5777 to speak to a knowledgeable representative about your individual situation. They are more than happy to help you navigate your options.

Once back online, after entering in some information about yourself, including your ZIP code and what type of coverage you need, a list of options and details about each plan will be returned to you. If you need help paying for your health care coverage, there may be assistance available in the form of subsidies. Use the eligibility calculator to learn more. One of the items that you may need some additional information about is plan metal levels, which break down how much your insurance will cover vs. how much you will be expected to pay out-of-pocket.

Important Note for Dependents Turning 26

If a dependent is nearing age 26, it’s time for them to think about the next step when it comes to health care coverage. This is because 26 is traditionally when dependents “age-out” of a parent or guardian’s health insurance plan. If you know someone who is about to start the process of purchasing or enrolling in their own health insurance plan for the first time, the tips included in this post may be a great place to start.

At CDPHP, we know health insurance can be confusing, it can be costly, and yet, it is extremely important. With the aforementioned recommendations, we hope that you will take comfort in knowing that you’ve made the right decision when it comes to health care coverage for you and your loved ones. And, if you choose CDPHP, you can rest assured that your health is in the right hands.

About the Author

John D. Bennett, MD, FACC, FACP, is president and CEO of Capital District Physicians’ Health Plan, Inc. (CDPHP), an award-winning, physician aligned, not-for-profit health plan based in Albany, NY. Bennett has held the position since 2008 after serving more than 10 years as chair, vice chair, and board member for CDPHP. During his tenure, CDPHP has been ranked among the top-performing health plans in New York and the nation, most recently named #1 in Customer Satisfaction in the 2023 J.D. Power Member Health Plan Study. Under his leadership, CDPHP has also become known as a model employer regionally and nationally and was recently named among the top five Best Companies to Work for in New York by the Society for Human Resource Management, as well as Forbes Best-in-State Employers 2022. Prior to joining CDPHP, Bennett served as founding member and CEO of Prime Care Physicians, PLLC. During his tenure, he co-led a team of 25 cardiologists and helped grow the practice to a 100-physician multi-specialty group. Bennett is board certified by the National Board of Medical Examiners and the American Board of Internal Medicine, with subspecialties in internal medicine and cardiology. He earned his medical degree at SUNY-Downstate Medical Center, Brooklyn, and a Bachelor of Science degree at Rensselaer Polytechnic Institute. Bennett completed an internship and residency in internal medicine and a fellowship in cardiovascular disease at Albany Medical Center. He is a Fellow of the American College of Cardiology and the American College of Physicians. Bennett is currently board chair for the Center for Economic Growth and the Capital Region Chamber, and vice chair for the Palace Theatre. Bennett also serves on the boards of the New York eHealth Collaborative (NYeC), the Alliance of Community Health Plans (ACHP), America’s Health Insurance Plans (AHIP), Rensselaer Polytechnic Institute, and Russell Sage Colleges. Bennett is a member of the New York Public Health and Health Planning Council where he helps shape decisions related to New York State's public health and health care delivery system. Well-known locally and nationally for advancing health care innovation, Bennett was recently named to Crain’s New York Business 2021 Notable in Health Care, as well as the Albany Business Review’s Power 50 list.

2 Responses to “How to Pick a Health Insurance Plan (or make the most of the one you have)”

Could I please speak to someone about a health plan for myself and spouse. We are currently cdphp members but are not being offered cdphp for 2017, thru my employer. Can you please help us!