November 10, 2023

Open Enrollment: The Most Daunting Time of the Year? It Doesn’t Have to Be!

Written by Ronny Bachrach


Eek, it’s already November, and while you usher in turkeys, football, and Black Friday sales, you must also embrace open enrollment! Choosing health insurance can be daunting, as there’s a lot to understand to pick a plan that fits you and/or your family best.


There’s a lot to consider:

  • What’s included in the plan?
  • Which providers are covered?
  • What medications are covered, and/or on what tier are they listed (it impacts pricing)?
  • Does it include eyes?
  • What about dental?

Then, there’s the cost to consider:

  • What is the monthly premium?
  • What is the annual deductible (that you have to reach to only then pay copays),
  • What is the out-of-pocket maximum per year?
  • What are the copays?
  • How much do my meds cost?
  • Is there a separate pharmacy deductible?
  • Do you use any medical devices or services that you need to check on pricing/coverage, like durable medical equipment or physical therapy?

The list goes on and can make it really challenging to weigh the costs and benefits against each other.


A question I didn’t even know to ask – and as you can see – I ask many, was, does the plan have any mandates applicable to my needs?


Unbeknownst to me, my family’s plan has a “Cancer Mandate,” which means that one of my daughter's medications that cost tens of thousands of dollars a month was absolutely free. While my daughter doesn’t have cancer, her medication for her Systemic Juvenile Idiopathic Arthritis (SJIA) is technically and primarily considered an oncology drug. So, check for mandates in your current and future plans, as they may benefit you in ways you did not expect.


My daughter just turned five, and long before I had her, I had to evaluate healthcare insurance plans based on my Type 1 diabetes. I have had to check for insulin prices based on the types of insulin I use, a well as durable medical equipment coverage for glucose sensors. In one case, my insulin is cheaper using a manufacturer coupon instead of running it through insurance. In another case, I shopped around and found more favorable insulin pricing through Amazon’s new pharmacy. Adding my daughter Sam to the mix has only made the process more challenging to check on the pricing and coverage of her extensive list of medications and providers.


So good questions to ask are:

  • Does your state or insurance provider have any (full or partial) mandatory coverage that might benefit you?
  • Do you qualify for any state-sponsored supplement or health plan based on chronic illness or disability? A great resource for this type of information would be a social worker in your healthcare facility.

There are often tools in place to help match your preferred providers to the available plans through your employer or state’s health connector.


There’s also a tool where you can input your medications to determine in what tier they would be billed per each plan. As an aside, check with the drug manufacturers about coupons. They might be better than the prices insurance offers. (Check out our blog on The Rx Games: How to Win at the Pharmacy)


It’s helpful to write out your known needs and try to make the best cost-benefit analysis to find the best fit. Frankly, it might mean paying a higher premium to avoid a high deductible or choosing a high-deductible plan in order to keep an existing or preferred provider.


It’s a lot to consider, but being organized in advance is super helpful. Make a list of your healthcare services, providers, medications, and equipment. Then start going through the available options.


Thankfully, many state-run healthcare marketplaces have people ready to walk through questions and plan options. Also, many companies have someone in HR who can field questions or put you in touch with a knowledgeable representative who can help the decision-making process.


As always, you can contact Cancer Sherpa, who will help you find a plan that is right for you or steer you toward the free resources that can further inform your decision.