How to Choose the Right Health Plan for You
Annual Enrollment is your opportunity to review your current health coverage and make changes for the upcoming plan year. For Group Insurance Commission (GIC) members, Annual Enrollment runs from April 1 – May 1, 2026.
Choosing a health plan is an important decision that impacts both your care and your budget. With so many factors to consider, taking time now to evaluate your options can help ensure you select coverage that best meets your needs.
Start by asking yourself these key questions:
- Are you eligible for the health plan based on where you live? Some health plans have residency or service area requirements. Make sure the plan you’re considering is available in your location.
- Are your current doctors in the plan’s network? If you have a preferred primary care provider (PCP) or preferred specialists, confirm they are contracted with your plan so you can continue seeing them.
- Are you comfortable electing a primary care doctor? Some health plans require you to choose a primary care doctor, so if you don’t feel comfortable selecting one, you may prefer a plan that doesn’t require one.
- Do you mind getting referrals for specialist visits? Certain health plans require referrals from your PCP before seeing a specialist. If flexibility is important to you, review this requirement carefully as some plans do not require referrals and give you the flexibility to choose.
- Do you travel frequently? If you travel often, check how your plan covers care when traveling nationally or internationally. Your health plan may or may not offer travel coverage.
- Do you have dependents who live out of state? If you have children, students and/or dependents living elsewhere, make sure your plan provides appropriate out-of-state coverage. Check that your health plan will cover these dependents.
- Are your medications covered? Review the plan’s prescription drug list (formulary) and compare costs for medications you take regularly.
Understand the costs before you enroll
Comparing plan costs can help you balance monthly premiums with potential out-of-pocket expenses. Here’s what to review:
- Network: Staying in-network helps you maximize benefits and lower your costs. Out-of-network care may cost more or may not be covered.
- Premium: The amount you pay each month for coverage. Plans with lower deductibles often have higher premiums.
- Deductible: The amount you pay for covered services before your plan begins to pay.
- Copay: A fixed amount you pay for certain services, such as doctor visits or prescriptions.
- Coinsurance: The percentage of costs you pay after meeting your deductible.
- Out-of-pocket costs: Includes deductibles, copays, and coinsurance.
- Maximum out-of-pocket limit: The most you’ll pay for covered services during the plan year. Once you reach this limit, your plan pays 100% of covered costs for the remainder of the year.
Make the most of Annual Enrollment
Even if you’re satisfied with your current coverage, Annual Enrollment is the ideal time to:
- Review any plan changes
- Reassess your family’s healthcare needs
- Compare costs across available options
- Confirm your doctors and prescriptions remain covered
Annual Enrollment for Group Insurance Commission members runs from April 1 – May 1, 2026. It’s the perfect time to review your health benefits plan to ensure you have coverage that meets your needs and budget. Learn more about Wellpoint health plans at wellpoint.com/mass/health-plans.