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Why, when, and how to switch to a new health insurance plan

Why, when, and how to switch to a new health insurance plan | UPMC Health Plan

Considering switching to a new insurance plan? Now’s the time to start that process. If you had individual or Marketplace coverage in 2015, you can change your health plan for 2016 starting on November 1, 2015.

Why switch?
There are lots of reasons why you might choose to switch to a new plan. Maybe you feel like you are paying too much for your insurance or your health care needs have changed. Or maybe you got married or divorced, had a child, or lost your existing health coverage. Changing to a new plan is as simple as signing up for new coverage, and in this post we will guide you through some important things to keep in mind while looking for a new plan and tell you how to sign up once you decide.

What to look for
Choosing a health plan can be complicated. There are lots of options and considerations to keep in mind, including cost-sharing, in-network vs. out-of-network, and benefits beyond health coverage. Here are some important terms and benefits to think about when you are searching for a new plan:

Copays: A copay is a flat fee that you pay each time you access care (for example, you pay $20 when you visit the doctor). This amount can vary by the type of covered health care service. So it’s important to take note of your copays when you are looking at new health plans.

Coinsurance: Coinsurance is your share of the costs of a covered health care service, calculated as a percent of the allowed amount for the service. Many plans have both coinsurance rates and copays, so it’s important to understand the difference between the two.

Provider network: You’ll want to make sure you understand what is considered “in-network” before you select a provider. “In-network” refers to any doctor, hospital or other health care provider that has agreed to be a part of your health insurer’s network of approved providers. This means that when the provider performs a treatment or service, they will generally be paid at a set rate. This contracted rate, or “allowed amount,” is the agreed-upon cost you and your insurer collectively pay the provider for the services you receive. If you are set on keeping the same doctors throughout your transition to new health coverage, make sure they are in your new plan’s network. UPMC Health Plan has a wide and diverse provider network that includes nearly 5,000 facilities and more than 500,000 physicians — so there’s a good chance your doctor is covered.

Benefits beyond health coverage: Beyond the health coverage and financial considerations of finding a new health plan, it’s important to look at the other benefits your plan may offer. Many health plans now offer online resources to track your health and find providers. These resources can be extremely valuable for individuals who choose to use them. For example, individuals who switch to UPMC Health Plan gain access to MyHealth OnLine, a health and wellness program that includes one-on-one support from health coaches, and online tools to track health goals.

How to sign up
You’ve decided to switch to a new plan, what now? Signing up for a new plan is simple. If you know which insurance company you want to switch to, you can sign up directly on their website. Get started becoming a UPMC Health Plan member today.

But if you’re not sure what plan you want, if want to compare plans, or if you want to see if you qualify for advance premium tax credits (sometimes called “subsidies”) to help pay for your insurance, you can visit the Marketplace. Just follow these steps:

  1. Create or log into your Marketplace account.
  2. Select your 2016 application and fill in or update the information as necessary.
  3. When you complete your application, you’ll get your eligibility results including information on any advance premium tax credits you qualify for. Then you can start exploring your options.
  4. Choose the plan that’s right for you and enroll.


If you’re interested in UPMC Health Plan, start the process by creating a personalized profile.