Open Enrollment: Choosing the Right Insurance Plan

Open enrollment is here, and if your child receives occupational therapy (OT), speech therapy (ST), or physical therapy (PT), choosing the right health insurance plan deserves a little extra attention.

It’s easy to focus on the monthly premium, but the plan with the lowest premium isn’t always the least expensive overall. Deductibles, copays, coinsurance, therapy benefits, and out-of-pocket maximums can make a big difference for families who use therapy regularly.

What Should You Compare?

When reviewing your options, look at:

• Monthly premium – What will you pay each month?

• Deductible – How much will you pay before insurance begins sharing costs?

• Therapy copay – What will you pay for each OT, ST, or PT visit?

• Coinsurance – What percentage of the allowed cost will you pay?

• Out-of-pocket maximum – What is the most you could pay for covered, in-network care out of pocket.

• Therapy visit limits – Are there limits on the number of visits?

• Prior authorization – Is authorization required for therapy?

• Network status – Is your child’s therapy provider in network?

Pay Special Attention to Therapy Benefits

Don’t assume OT, ST, and PT are covered the same way under every plan. Check specifically for:

• Occupational therapy

• Speech therapy

• Physical therapy

• Outpatient therapy

• Visit limits

• Prior authorization requirements

If you’re unsure, call the insurance company and ask specifically about outpatient OT, ST, and PT benefits.

Is Your Child’s Therapist In Network?

If your child is already receiving therapy, this should be high on your checklist.

Make sure your child’s therapy clinic is in network with the plan you’re considering. In-network care generally costs less because the provider has a contracted rate with the insurance company.

Don’t Assume Your Current Coverage Will Stay the Same

Even if your child has been coming to our clinic for years, your insurance benefits may change from one year to the next.

Before enrolling, we recommend asking your insurance company:

1. Is HHH Pediatric Therapy in network?

2. How are OT, ST, and PT covered?

3. Is therapy subject to the deductible?

4. What is the copay or coinsurance per visit?

5. Are there therapy visit limits?

6. Is prior authorization required?

7. What is the out-of-pocket maximum?

Your insurance company is the best source for confirming your specific benefits.

The Bottom Line

If your child receives therapy, choosing insurance is about more than finding the lowest monthly premium.

Consider the total cost of care, including your deductible, therapy copays, coinsurance, out-of-pocket maximum, visit limits, and network status.

Taking a few extra minutes during open enrollment can help you choose a plan that better fits your child’s needs—and your family’s budget.