Making the smart choice during open enrollment

Cost is only one factor to consider. Who will deliver your care?

September 27, 2016
UCI Health open enrollment 2016
UCI Health primary care physicians can now be found in neighborhoods throughout Orange County. For more information, visit

Fall is the time of year when everyone needs to go shopping — for their healthcare.

Open enrollment is the period when people can make changes to their health plans for the coming year. For Medicare, open enrollment is Oct. 15 to Dec. 7.

For health plans through the Affordable Care Act’s marketplace exchange, it runs from Nov. 1, 2016, to Jan. 31, 2017.

Open enrollment periods for work-based plans are set by employers and often occur in the fall.

But before you choose your coverage, shop around. Live Well spoke with Dr. Manuel Porto, president and CEO of UCI Health Physicians & Surgeons and a specialist in maternal-fetal medicine, about what to consider when selecting health insurance.

Dr. Manuel Porto
Dr. Manuel Porto

Why should people spend time doing some homework during open enrollment and before selecting a plan?

Healthcare options are changing, especially in recent years with the Affordable Care Act. The health plan you previously had may have gone through some significant modifications, your preferred providers may have changed networks, or your health risks may be different. It’s important to consider these factors in choosing to continue coverage or start new coverage.

How do I know what kind of coverage I need?

No one has a crystal ball, but if you’ve been seeing your primary care doctor annually, you should have an idea of the care you’ll need going forward. Make sure you opt for a plan that provides that coverage, such as maternity care, prescription drugs or an elective surgery you’re considering.

What about provider deductibles or fees for services?

If your family is very healthy, you might choose a plan with a very high annual deductible and co-pays. But if a family member requires ongoing therapy, surgery or an inpatient admission, you may want to choose a plan where your out-of-pocket costs are not as high.

What about provider networks?

If you choose an HMO or PPO plan, make sure that your preferred providers, specialists and care centers are part of the covered network. If they’re not, your out-of-pocket expense may increase dramatically.

Will I be able to receive care from UCI Health physicians?

Primary care

UCI Health contracts with most major medical plans and you’re likely to find your current provider or select a new, highly qualified provider in our large network of primary care physicians and specialists. Plus, we’re expanding our network throughout Orange County, including in the cities of Orange, Irvine, Tustin, Yorba Linda, Brea, Costa Mesa/Newport Beach, Anaheim and Santa Ana. We have more than 100 physicians recognized as the “Best Doctors in America” and nationally recognized programs in nursing, as well as cancer, high-risk obstetrics, neonatal, digestive disease, stroke and trauma care. Our SeniorHealth Center has some of the few board-certified geriatric specialist physicians in Orange County. And our hospital, UC Irvine Medical Center, has been on the U.S. News & World Report list of America’s Best Hospitals for 16 consecutive years, recognized this year for orthopaedics and ear, nose and throat specialties, and is ranked highest in Orange County.

What factors do people tend to overlook when choosing a health plan? The tendency is to look only at whether their primary care provider is in the covered network. It’s also important that top-tier specialists and facilities are in the network. It’s something to discuss with your primary care physician. UCI Health’s grouping of primary care and specialty physicians together in convenient locations across the county allows for seamless referrals, sometimes even within the same suite of offices.

What special concerns should medicare patients think about? There are several parts to Medicare. Basic Medicare — parts A and B — covers hospitalization and physician services. Part D covers pharmacy. You can also purchase Medicare Supplemental Insurance to help pay for some of the costs that Medicare doesn’t cover. Many insurers offer Medicare Advantage plans, known as part C, that combine parts A, B and D — often for one monthly price. Many Medicare Advantage plans function like HMOs. If you’re approaching Medicare eligibility age, you should investigate all options to see which plan is best for you. Click to learn more about Medicare ›

For more information about choosing UCI Health during open enrollment, visit or call 844-227-3824.

— UCI Health Marketing & Communications
Featured in UCI Health Live Well Magazine Fall 2016