20 msfocusmagazine.org Navigating the maze of health insurance can be confusing and frustrating. Once you have learned the lingo, the next challenge is to select a health insurance plan that will help you successfully manage your MS care. Choosing thewrong insurance or not knowing yourinsurance rights can lead to more relapses and poor health outcomes. The following scenario offers practical tips and takeaways for selecting a new health insurance plan when living with MS. Imagine you were just informed that your employer is switching insurance providers and there will be an open enrollment period. The open enrollment period provides you with three options: an HMO plan, a PPO plan, or a high deductible plan. How do you choose a plan that is right for you? The first thing thatyouwillwant to consider is what healthcare services you will need for the following year. In this scenario, you anticipate that you will have two neurology visits, two MRIs and take an oral MS treatment that gets refilled once a month. That means without any catastrophic health episodes, like an MS exacerbation, you will need to have at least four health appointments and twelve prescription refills, all in addition to your annual physical. Since you are requiring a higher level of care, you probably don’t want to choose the high deductible plan. Sure, that plan has the lowest premium, but if you do not experience enough health episodes to coverthe deductible, all your health expenses for the year could end up being out-of-your-pocket. So then you can narrow down your options to two. The PPO plan allows you to see your MS specialist without a referral, but has a higher premium than the HMO plan. The decision here comes down to whether or not you want to coordinate your care through a primary care physician (PCP). If you see multiple specialists, in addition to your MS neurologist, having a PCP coordinate care may be a good option. If MS is your chief concern and you are otherwise healthy, you may want to pay a little extra each month for the convenience of skipping the PCP and going straight to your MS specialist. Next, you want to look at the in-network providers and formulary. You will want to confirm that your current MS specialist is in-network with the new insurance plan. If your current MS specialist is not in-network, you will have to decide whether to continue carewith this specialist. Out-of-network claims Navigating a Change of Insurance with MS By Matt Cavallo Hot Topics