Selecting the Best Coverage for Your Arthritis Care: Open Enrollment Checklist

Use this checklist to make sure you get the best plan for your healthcare needs.

  • Health Expense Audit. Review all expenses from the previous year (premium, copays, deductibles and out-of-pocket payments for covered and non-covered services). Then, calculate estimated expenses for the new plan year. Discuss potential changes in your treatment plan for the upcoming year with your doctor before calculating estimated expenses.
  • Financial Assistance Audit. Review all financial support you received from the previous year and look for new programs. Keep track of application deadlines and check the criteria to make sure you qualify. You should find out if the financial assistance applies to your deductible or out-of-pocket maximum.
  • Benefit changes. Review the summary of benefit for coverage changes from the previous year (office visits, prescription drugs, hospital or lab services, preventative health, physical and occupational therapy, mental health services, durable medical equipment and other benefits). Paying the same monthly premium as the previous year doesn't mean that the same benefits are covered or at the same level.  For example, your physical therapy coverage may change from 12 visits per year to three visits per year.  Never assume that premiums, deductibles, copays and coinsurance are the only differences between plans, even when the plan is offered by the same company.
  • Premium and deductible.  Check for changes in your monthly premium and/or annual deductible (i.e. individual and family deductibles). Keep in mind that you may have separate medical care, drug and durable medical equipment deductibles.  Usually, a lower premium means a higher deductible. 
  • Copay and coinsurance.  Check for changes in copayments or coinsurance (the percentage you must pay for services) for your most commonly used services and products and well as for emergency and hospitalization services.
  • Drug formulary. Make sure the drugs you take are on your plan’s formulary and check which tier they are on. Your primary arthritis drug may be moved to a higher tier and that means you may pay more money out of pocket.
  • Provider network. Never assume that your providers are still in-network even if the plan is offered by the same insurer. Always ask your provider’s office to confirm, because sometimes the insurers’ online directory may not be up to date.  Keep in mind that a provider is not automatically in-network for all the plans that an insurer provides.  For example, a provider may participate in the insurer's PPO plan but not the HMO plan  You will also need to confirm the in-network pharmacies and lab facilities.  
  • ACA compliance. Check whether available plans cover hospitalization, maternity and newborn care, preventive services, mental health and substance abuse treatment and other requirements of the Affordable Care Act. If not, you’ll need a plan through a state or federal exchange if you need these services. If your income falls below certain limits you may be eligible for a subsidy to reduce the premium on an exchange plan.
  • Flexible Spending Account.  Check if your employer offers an FSA. Find out the grace period and rollover policy so you don’t lose unspent balances.
  • Health Incentive Programs. Find out whether your employer offers a financial incentive for good health practices e.g. exercise, healthy eating and weight management. These monies can be applied to out of pocket expenses.
  • Spouses and dependents.  If your spouse, dependents or adult children under age 26 are currently covered through your employer-sponsored plan, make sure that your employer is still extending coverage to these beneficiaries. Also, see if your employer has changed the amount they’ll contribute toward dependents’ monthly insurance premiums. If your spouse’s employer offers insurance, compare costs and benefits with your current plan.
Stay in the Know. Live in the Yes.

Join the Live Yes! Arthritis Network. Tell us a little about yourself and you will receive emails packed with the latest information and resources to live your best life and connect with others.

 
I Want to Contribute
I Need Help
  • Donate

    Every gift to the Arthritis Foundation will help people with arthritis across the U.S. live their best life.

  • Volunteer

    Join us and become a Champion of Yes. There are many volunteer opportunities available.

  • Live Yes! INSIGHTS

    Take part to be among those changing lives today and changing the future of arthritis.

  • Partner

    Proud Partners of the Arthritis Foundation make an annual commitment to directly support the Foundation’s mission.

Donate


Make a Donation

Help millions of people live with less pain and fund groundbreaking research to discover a cure for this devastating disease. Please, make your urgently-needed donation to the Arthritis Foundation now!

Become a Member

Become an Arthritis Foundation member today for just $20. You'll receive a year's worth of Arthritis Today magazine, access to helpful tools, resources, and more.

Make a Honor or Memorial Gift

Honor a loved one with a meaningful donation to the Arthritis Foundation. We'll send a handwritten card to the honoree or their family notifying them of your thoughtful gift.

Volunteer


Volunteer Opportunities

The Arthritis Foundation is focused on finding a cure and championing the fight against arthritis with life-changing information, advocacy, science and community. We can only achieve these goals with your help. Strong, outspoken and engaged volunteers will help us conquer arthritis. By getting involved, you become a leader in our organization and help make a difference in the lives of millions. Join us and become a Champion of Yes.


More About Volunteering

Live Yes! INSIGHTS


Give Just 10 Minutes.

Tell us what matters most to you. Change the future of arthritis.

By taking part in the Live Yes! INSIGHTS assessment, you’ll be among those changing lives today and changing the future of arthritis, for yourself and for 54 million others. And all it takes is just 10 minutes.

Your shared experiences will help:

- Lead to more effective treatments and outcomes
- Develop programs to meet the needs of you and your community
- Shape a powerful agenda that fights for you

Now is the time to make your voice count, for yourself and the entire arthritis community. 

Currently this program is for the adult arthritis community.  Since the needs of the juvenile arthritis (JA) community are unique, we are currently working with experts to develop a customized experience for JA families. 


How are you changing the future?

By sharing your experience, you’re showing decision-makers the realities of living with arthritis, paving the way for change. You’re helping break down barriers to care, inform research and create resources that make a difference in people’s lives, including your own.

Get Started

 

Partner


Meet Our Partners

As a partner, you will help the Arthritis Foundation provide life-changing resources, science, advocacy and community connections for people with arthritis, the nations leading cause of disability. Join us today and help lead the way as a Champion of Yes.

Trailblazer

Our Trailblazers are committed partners ready to lead the way, take action and fight for everyday victories. They contribute $2,000,000 to $2,749,000

Visionary

Our Visionary partners help us plan for a future that includes a cure for arthritis. These inspired and inventive champions have contributed $1,500,00 to $1,999,999.

Pioneer

Our Pioneers are always ready to explore and find new weapons in the fight against arthritis. They contribute $1,000,000 to $1,499,999.

Pacesetter

Our Pacesetters ensure that we can chart the course for a cure for those who live with arthritis. They contribute $500,000 to $999,000.

Signature

Our Signature partners make their mark by helping us identify new and meaningful resources for people with arthritis. They contribute $250,000 to $499,999.

Supporting

Our Supporting partners are active champions who provide encouragement and assistance to the arthritis community. They contribute $100,000 to $249,999.

More About Partnerships