Resources and tips to help you choose the right health plan.
What you should know before selecting a plan
Questions to ask yourself when evaluating your health plan options
Are there specific doctors, specialists, or hospitals that you want access to?
If yes, you’ll want to make sure these providers are in the plan’s network. Narrow your plan options by eliminating those whose networks do not include these providers. To find out if your providers are in the Blue Shield network for the plans being offered to you, visit our Find a Doctor tool.
Is it important for you to have access to as many California specialists and hospitals as possible in case of illness or injury?
If yes, you may want to choose a PPO plan (if offered by your employer), as they offer you the most choice and flexibility. With a PPO plan, you can also see providers who are not in the PPO network. However, please be aware that you may pay more for non-network providers than you would for network providers.
Do you or your family members have a chronic condition such as asthma, cancer, or diabetes?
If yes, you will want to compare plan coverage along with estimated copays and deductibles for specialists, hospital stays, medications, medical equipment, etc. Typically, you will have fewer out-of-pocket costs with an HMO plan than a PPO plan, but a smaller network of doctors and hospitals from which to choose.
Do you or any family members take prescription drugs on a regular basis?
If yes, be sure to review each plan’s prescription drug coverage, including drug copayment tiers and prior authorization and exception request processes.
Do you anticipate any medical procedures, treatments, or special services in the next year such as surgery, pregnancy, colonoscopy, etc.?
If yes, compare coverage for the specific medical care you may need such as specialists, hospitals, medication, etc. Typically, an HMO plan covers most of the costs but offers a more limited network of doctors and hospitals than a PPO plan.
Do you travel often for work or pleasure?
If yes, you may want to choose a Blue Shield plan since all our plans offer coverage for urgent and emergency care while on vacation or traveling for business anywhere in the world.