Which statement correctly reflects expectations about plan change?

Which statement correctly reflects expectations about plan change?

• A. The new plan will always be cheaper
• B. The new plan will remove all prior coverage
• C. The new plan may have different access to providers and medications
• D. The new plan will have identical features and costs

Answer: (C)

Plans change can affect who you can see and which medications are covered. When you move to a new plan, the network of doctors and hospitals may be different, and the formulary (which drugs are covered) can change. A doctor you used to see might not be in-network, and a medication you rely on might no longer be covered or could require prior authorization, a different copay, or step therapy. Because of these possibilities, it’s not safe to assume costs or access will stay the same. Always review the new plan’s provider directory and formulary, and read the annual notice of change and evidence of coverage to understand what will differ. The other ideas—that the plan will always be cheaper, that all prior coverage will be removed, or that features and costs will be identical—don’t generally reflect what happens with plan changes.

Plans change can affect who you can see and which medications are covered. When you move to a new plan, the network of doctors and hospitals may be different, and the formulary (which drugs are covered) can change. A doctor you used to see might not be in-network, and a medication you rely on might no longer be covered or could require prior authorization, a different copay, or step therapy. Because of these possibilities, it’s not safe to assume costs or access will stay the same. Always review the new plan’s provider directory and formulary, and read the annual notice of change and evidence of coverage to understand what will differ. The other ideas—that the plan will always be cheaper, that all prior coverage will be removed, or that features and costs will be identical—don’t generally reflect what happens with plan changes.