DECEMBER 2016 ON HEALTH CONSUMER REPORTS 11 CONSUMERREPORTS.ORG/HEALTH O pen enrollment is here, the pe- riod of time during which you may sign up for—or change—your health insurance for 2017. For many individual and family health plans, including insurance that can be pur- chased through the Affordable Care Act, open enrollment ends Jan. 31. If you are covered by Medicare, Dec. 7 marks the end of open enrollment. Between now and then, you can switch from origi- nal Medicare to a Medicare Advantage plan (the private managed-care version of Medicare), or vice versa, replace one Medicare Advantage plan with another, or change your Medicare Part D (pre- scription drug) plan. But when do you really need to change your plan? Here, four instances in which switching may be warranted: THE DOCTOR YOU WANT TO SEE DOESN’T TAKE YOUR INSURANCE It’s good for your health to work with healthcare providers you trust, accord- ing to research. For example, a 2014 PLOS One analysis of 13 studies found that a positive doctor-patient relationship can make a real difference for conditions such as asthma, obesity, and osteoar- thritis pain. But right now provider lists are in flux at a number of health insurers, so you can’t assume that the doctors you prefer who currently take your insurance will do so in 2017. What to do Contact the billing depart- ments of the healthcare providers you want to see and make sure they will con- tinue to accept the specific insurance product you now have. Check with your preferred hospital as well and confirm with your insurer. If key healthcare pro- viders are not on the 2017 list for your insurer, you may need to ask which in- surance products they will accept in 2017 and consider a new plan. Proactive Patient PLAN PRICE IS GOING UP, UP, UP A Kaiser Family Foundation analysis of select states predicts that your insurance premiums for plans purchased directly through state and federal marketplaces may go up for 2017—and by more than they have in recent years. Insurers re- quested an average rate increase of 9 per- cent. (But most people who buy ACA plans will be somewhat shielded from increases because they’ll get a tax credit to offset premium costs.) What to do Think about what you really need and don’t automatically rush out to buy the cheapest plan. Those plans may cost more in the long run because they often come with higher deductibles (the amount of money you have to spend be- fore insurance kicks in), higher co-pays (the flat amount you will be asked to pay every time you visit a doctor, hospital, or other healthcare provider), and steeper coinsurance (the percentage of the bill you have to pay for treatment even after you meet your deductible). Those out- of-pocket expenses, which can run into thousands of dollars, may tempt you to delay needed care. And some of the lower-cost plans have smaller networks of doctors, limiting your choice of providers. DRUG COSTS ARE SKYROCKETING Every insurance plan that offers prescrip- tion drug benefits has a formulary, a list of medications it covers, at least in part. Each medication in a formulary is usu- ally placed in a tier that determines your out-of-pocket cost. For tier 1 medications, which are usually generic, you may pay only a few dollars. As the tier numbers go up, so does the amount you pay. What to do Formularies often change year to year, so check with your plan to make sure it’s not removing a medication you take regularly from its covered list. If it is, you may need to investigate the formularies of other insurance compa- nies. But first, file an appeal with your current insurer or ask your doctor to switch you to a covered medication with similar benefits. If you take multiple high- tier medications, you’ll find cost-cutting tips at CRBestBuyDrugs.org. YOUR PLAN IS NOT AVAILABLE In some cases, you may be forced to choose a new plan. For example, Aetna, Humana, and United Healthcare have announced that they are dropping out of many ACA state marketplaces, citing financial losses. What to do Find comprehensive insur- ance buying advice at ConsumerReports. org/healthinsuranceinfo. ORLY AVITZUR, M.D., M.B.A., is Consumer Reports’ medical director. Board certified in neurology, she is a fellow of the American Academy of Neurology, a clinical instructor at the Yale University School of Medicine, and a medical consul- tant to the New York Rangers hockey team. When to Change Health Insurance The 4 times when it makes sense to consider a new plan or provider It’s open enrollment, the time of year when you may need to make big decisions about your health insurance. Orly Avitzur M.D., M.B.A. ILLUSTRATION BY: DAN PAGE