Your 2025 health plan shopping checklist

Open enrollment is the time each year when you can make changes to your health insurance benefits, such as changing your plan or adding family members.

This year’s open enrollment period in the individual market — for people buying insurance directly from a health plan or through Covered California™ rather than through an employer — will begin Nov. 1, 2024, and runs through Jan. 31, 2025.

“Making sure that you and your loved ones have access to the best care is critical,” explains Don Truong, director of sales at Sharp Health Plan. “That's why we put together the following shopping checklist to help you pick the right health insurance provider and benefit plan for next year.”

Your health insurance shopping checklist:

1. Shop for a health plan based on quality.
   Consider the quality of a health plan before purchasing health insurance. It’s also important to check on the quality of a health plan’s network — the health care facilities and doctors that you’ll have access to through your health plan.
   
   The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program conducts annual surveys on patient experience and shares them with health plans, providers and facilities. Since launching in 1997, the CAHPS Health Plan Survey has become the national standard for measuring and reporting consumers’ experiences with their health plans.
   
   “For example, Sharp Health Plan is the highest member-rated commercial health plan in California, with the highest member rating for customer service, health care, specialist and care coordination,” explains Truong.
    

2. Consider what care you may need in the future.
   Determine what health care services you’ll likely need to use for the upcoming year. This includes specialist appointments and prescriptions. If you or anyone in your family has a new health condition, prescription or is planning to undergo surgery, you’ll want to take that into consideration when selecting a plan.
    

3. Know how much you’ll pay and check to see if you qualify for financial assistance.
   The amount of coverage you get depends on the type of plan you choose. Typically, the more coverage you have, the higher your monthly premium will be. Most health plans share costs with you through deductibles, copayments and coinsurance. It’s important to understand the services a health plan covers and any associated out-of-pocket costs before picking a plan.
   
   Health coverage is available at reduced or no cost for people with incomes below certain levels. The Inflation Reduction Act is offering additional premium assistance through 2025. Even if you haven’t qualified for financial help in the past, you may now. Check with Sharp Health Plan’s enrollment specialists to see if you qualify by calling 1-858-499-8211 or by contacting Covered California.
   
   Most people who qualify can expect to see a much lower bill. “Sharp Health Plan is offering select plans through Covered California for as low as $0 a month, based on eligibility,” Truong says.
    

4. Make a list of must-have prescriptions, doctors and facilities.
   Every health plan has a network of providers, pharmacies and hospitals for you to use when you need to get care. It also has a list of prescriptions it covers. When evaluating a health plan, it’s a good idea to check out their network to ensure your doctors and prescriptions are covered.
   
   “Look for ways to streamline your care,” Truong says. “Sharp Health Plan gives you direct access to Sharp. Your health insurance coverage and your health care are managed in a more seamless and coordinated way, making it easier to get the care you need.”
    

5. Prepare your information.
   When you apply for or renew your coverage, you’ll need to provide some information about you and your household, including:
   
   * The names, dates of birth and/or Social Security numbers of everyone you want to cover on your plan
   * Your estimated household income for 2024 (pre-tax), if you want to see if you qualify for financial help
   * Employer names, addresses and phone numbers for everyone in your household
   * Immigration documents (if applicable)

If you can check off the items on the list above, then you’re ready to get insured for 2025. However, if you still have questions, there are many resources available.

“We want to make sure people know that they can get help,” says Truong. “There are lots of community resources available with experts whose job is to help you find the right coverage.”

Sharp Health Plan hosts free in-person and virtual enrollment labs and online seminars, where you can learn about health insurance options and, if you feel ready, get help with enrollment at no cost to you. You can also contact the Covered California service center for support.

Sharp makes it easy to get the care you need. Learn more at sharp.com/choosesharp.