Helpful suggestions from Wellpoint
With Open Enrollment – be it with the GIC or at the local level – upon us, members may be facing the pivotal question: What plan is right for me? Now is the perfect time to review your health plan options to ensure you have coverage that meets your needs. To assist members, we reached out to Wellpoint, the largest insurer, by far, of GIC retirees, for helpful suggestions to aid members in answering that question and exploring their options.
Mass Retirees thanks Wellpoint General Manager David Morales and his staff in providing key questions that members may want to consider as they shop for the best health plan value. Here’s what they suggested.
- Is the health plan available where you live? Eligibility for a health plan can differ by residency – be sure the plan is available where you live. If you travel often, check if the plan will provide coverage nationally. Most Medicare Supplement plans available through the GIC offer national coverage, including Wellpoint’s Medicare Extension, the most popular plan for Massachusetts state retirees.
- Are your doctors and hospitals covered? It’s important to check if your doctors and hospitals are included in the health plan’s network. While a Medicare supplement plan, like those offered by Wellpoint (see page 10) covers virtually all doctors and hospitals, the coverage by a Medicare Advantage (MA) plan may have a limited network of healthcare providers.
- Are you comfortable electing a primary care provider (PCP)? If you don’t feel comfortable selecting a PCP and want broader access, you may prefer a plan that doesn’t require one. While we encourage you to work with a PCP, some plans, do not require it.
- Are you okay waiting for referrals to see a specialist? Most health plans require referrals from your PCP before seeing a specialist. If flexibility is important to you, review this requirement carefully as some plans do not require referrals and give you the flexibility to choose which providers you want to visit.
- How much will you pay in out-of-pocket costs? Healthcare costs are one of the most pressing concerns for retirees. Calculate what your potential outof- pocket costs may be by reviewing the monthly premiums, copays, and deductibles. Understanding your costs will help you gain peace of mind.
- What additional benefits does the plan offer? Some plans offer services to help you proactively manage chronic conditions or specific health issues. For example, Mass Retirees was instrumental in fostering the partnership between Wellpoint with Senscio Systems, offering members with two or more chronic conditions a virtual care management program, Ibis, with real-time monitoring and one-to-one monthly support.
In closing, Wellpoint pointed out to us that it’s also important to check if the plan offers personalized digital tools and virtual care options to give you easy access to all your plan information and care needs. For example, Wellpoint’s Sydney Health app lets members check benefits, claims, and cost share information. Members can also access a live chat feature to connect with customer service for quick answers, download and use digital ID cards, and have a live video visit with board-certified doctors.
“We agree with Wellpoint that annual enrollment is the best time to evaluate your health plan options,” adds Association President Frank Valeri. “This is particularly true for our non-Medicare members who may be presented with a wider range of differing plans.
“No question that one should be informed when attempting to answer the question what plan is right for them. Here in The Voice, our weekly email/video messages and other media outlets, Mass Retirees is striving to help our members to reach an informed decision.
“Thank you again David and Wellpoint in this important endeavor. And, we look forward to continuing this work with you at our joint Tele- Town Hall Meeting on April 6th.”