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Open Enrollment Choices

, choosing a Blue Cross Blue Shield of Michigan or Blue Care Network health plan can be confusing. We’ve created this page to make your choice easier.

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Your health care needs

Choosing an affordable health plan is usually based on your current health and how much you think you’ll need to use it. Let’s look at some factors that can help you decide.

What matters most to you in a health plan?

Health care costs are a big part of your yearly budget. Knowing how much you’ve spent in the past can help you decide if your current plan is right for you. Log in to your online account to:

View and download your past claims
See how much you spent on care
Filter between your past claims

You may already have a primary care provider or specialist. If they’re out of your network, you’ll likely pay more to see them. To see if your provider is part of a plan you’re interested in:

Log in to your online member account
Select Find Care under Doctors and Hospitals
Select the health plan you are interested in
Search providers in your network

Each health plan covers medications differently. If you use certain ones on a regular basis, it’s a good idea to find out if and how these drugs are covered under each plan.

Health plans differ on how they cover chronic conditions such as diabetes, heart disease or asthma. Because treatment for these conditions can be expensive, you may want to consider a plan with a higher monthly premium, but lower deductible and out-of-pocket maximum.

Typically, out-of-pocket costs for surgery will be different depending on your health plan and other factors, like meeting your deductible. Many surgeries will also require follow-up care, like physical therapy — which can be very costly.

If you know you’re having surgery this year, do the math. Choosing the right plan will likely save you a lot of money. You can see average costs for procedures by logging in to your online member account. Select Estimate Your Cost under Find Care to search providers, services and estimated health care costs.

Understanding your costs

A deductible is the amount you pay for health care services before your health insurance begins to pay. If your health plan deductible is $1,500, you’ll pay 100% of eligible health care expenses until the bills total $1,500. After that, you share the cost with your plan by paying coinsurance.

Coinsurance is your share of the cost of a health care service, usually a fixed percentage of what Blue Cross pays your provider. You start paying coinsurance after you’ve paid your health plan deductible.

For instance, you’ve paid $1,500 in health care expenses and met your deductible. When you see a provider, instead of paying all costs, you and your plan share the cost. For example, your plan pays 70%. The 30% you pay is your coinsurance.

A copay is a fixed amount you pay for a health care service, usually when you receive the service. The amount can vary by the type of service. Your health plan determines when you pay a copay and how much it is for different types of services.

You may have a copay before you’ve finished paying toward your deductible. You may also have a copay after you pay your deductible and when you owe coinsurance.

An out-of-pocket maximum is the most you’ll pay for services you receive during a plan year. It includes your deductible, coinsurance and copay.

Once you’ve reached your out-of-pocket maximum, your health plan pays 100% of the allowed amount for health care services. You will still be responsible for your monthly payment or premium and health care services not included in your plan’s benefits.

A Health Savings Account, or HSA, is a pre-taxed savings account that is paired with high deductible, lower premium plans. Instead of paying for a higher premium, lower deductible health plan, you put the money saved in an HSA to use on qualified medical, pharmacy, dental and vision expenses. The account is yours and you’ll never lose what you put in. Read about HSAs.

A Flexible Spending Account, or FSA, is an account your employer provides to help you save money on taxes and pay for qualified expenses. What makes them flexible? They give employers the most options on which accounts to offer. Your employer can keep any funds left at the end of year. Learn more about FSAs.

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Your life events

Getting the most from your Blue Cross health plan means finding the right coverage for every stage of life. Ready for the next phase? Here are a few more questions to ask yourself.

What to consider when choosing an insurance plan

Ready to hit the open road? It’s important to understand the types of care that travel with you:

24-Hour Nurse Line: Talk to a registered nurse for health advice concerning symptoms you may have. They can help you decide to self-treat or see a provider at no cost to you.
Urgent care center: Get in-person treatment for moderate illnesses and injuries. Urgent care is covered, no matter where you are in the U.S.
Virtual Care: Get 24/7 urgent care when you need it, wherever you are and without an appointment. Virtual mental health care is also available with an appointment.

Not all health plans cover routine care in areas out of your network. If you’re going to require routine care while traveling, you may want to consider a plan that includes this type of coverage no matter where you go in the U.S.

Moving into a new home is exciting. Be sure you consider a few things before choosing your health plan:

Do you want to stay with your current provider?
Will it cost you more to keep your current provider?
Would you consider choosing a new provider?

If your current provider doesn’t work within a plan, you’ll likely pay more for care. Additionally, their office may be miles from your new home, costing you more in gas and travel time.

Planning on taking some big steps? You may want to ask yourself some big questions:

Will your new spouse be joining your health plan?
Does or will your new spouse have complex medical needs?
Could your pregnancy or delivery be complicated?
Could your baby have unexpected medical needs?

No one likes to think about their spouse or child being sick. Still, it’s never a bad idea to consider these possibilities when making your decision.

Understand your health plan usage and needs

There are many things to consider as you navigate open enrollment. To gain a deeper understanding of how you’ve used your current plan, log in to your online member account.

From your member account, you’ll be able to:

View or download a report of this year’s claims
See how much you’ve spent toward care
See how much was covered for the year
Filter between all your claims

Sources and disclaimers

*Teladoc Health^® is an independent company that provides Virtual Care Solutions on behalf of Blue Cross Blue Shield of Michigan and Blue Care Network.

All Virtual Care services from Teladoc Health are separate from virtual care other providers may offer. Remember to follow up with your primary care provider. Your plan may have copayments, deductibles and out-of-pocket costs. 

**Condition Management programs are offered at no cost to you and covered family members with diabetes or hypertension with coverage through a Blue Cross Blue Shield of Michigan or Blue Care Network health plan. The Diabetes Prevention program is offered to you and covered family members who meet specific health criteria and are covered under a Blue Cross Blue Shield of Michigan or Blue Care Network health plan. To enroll in the program, members must complete the Centers for Disease Control and Prevention risk assessment and meet specific criteria. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.

^†Maven is an independent company supporting Blue Cross Blue Shield of Michigan and Blue Care Network by providing family building and maternity support services.

^††OncoHealth is an independent company supporting Blue Cross Blue Shield of Michigan and Blue Care Network by providing cancer support services.

^†††The Blue365 program is brought to you by the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield Association is an association of independent, locally operated Blue Cross and/or Blue Shield Companies. Blue Cross Blue Shield of Michigan is an independent licensee of the Blue Cross and Blue Shield Association.

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