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How to Get the Right Medical Option

Now that you understand the basics, it’s time to put it all together. Get confident in your choices—before you enroll—by finding answers to some really important questions. And breathe easy knowing online tools will make it easy to make it yours.

Don't wait. Get ready now so when it’s time to enroll, you’ll have answers to the following questions.

Which Providers Are in the Carrier’s Network?

Why It Matters
Seeing out-of-network providers will cost you more—sometimes a lot more. For example, you will have to pay more through a higher deductible and higher coinsurance. You'll also have to pay the entire amount of the out-of-network provider's charge that exceeds the maximum allowed amount.

What to Do
Choose an insurance carrier whose network includes providers (e.g., doctors, specialists, hospitals) critical to your care.

Do not rely on your provider’s office to know the carriers’ network(s). To search for providers:

  • Check out the insurance carrier preview sites.
  • When you enroll, check the networks of each insurance carrier you’re considering on NMGbenefits.com. For the best results:
    • Search for your provider by name—not medical practice.
    • Check only the office location(s) you are willing to visit.
    • When searching for a facility, use the complete facility name and confirm whether the specialty of the facility is covered in-network.

Important! Do not rely on your provider’s office to know the carriers’ network(s). If you have any uncertainty (for instance, covering out-of-area dependents) or you need the network name, call the insurance carrier.

Even if you can keep your current insurance carrier, the provider network could be different and can change, so always check the provider networks on the carrier preview sites before making a decision.

How Will My Prescription Drugs Be Covered?

Why It Matters
Each pharmacy benefit manager has its own rules about how prescription drugs are covered. To avoid potentially costly surprises, you need to do your homework.

What to Do
If you or a covered family member regularly takes medication, make sure you’re comfortable with the pharmacy benefit manager's coverage for drugs you and your covered family members need:

  • Call OptumRx (if you're considering coverage under Aetna, Blue Cross Blue Shield of Texas, Cigna, and UnitedHealthcare) or the medical insurance carrier (for all other carriers) before you enroll. Get a list of prescription drug questions to ask the insurance carriers.
  • If you’re currently taking a more expensive brand name prescription drug, ask your doctor (or pharmacist) if a generic is available to you.
  • When it’s time to enroll, you can use the prescription drug search tool to look up your medication, see how it will be classified (Tier 1, Tier 2, Tier 3), and more.

Which Medical Coverage Level Is Best for Me?

Why It Matters
You want to get the right amount of coverage for your needs at the best price. Get help choosing the right level of coverage.

What to Do
If you need help deciding, there are tools to help you:

  • Get an overview of your medical coverage levels.
  • See which coverage level could be best for you with the Help Me Choose tool. By answering a few questions on NMGbenefits.com, you can see which option could be a good fit for you and your family.
  • Compare your options side by side when you enroll on NMGbenefits.com. Just check the boxes next to medical options you want to review and click Compare (under the check marks). You can quickly see which options cost more out of your paycheck and which options cost more when you get care. (You may also find Summaries of Benefits and Coverage for comparison on NMGbenefits.com.)

Which Medical Insurance Carrier Is Best for Me?

Why It Matters
All insurance carriers are different. Each carrier will offer its own price for each coverage level, and you'll be able to see all of the prices in one place on NMGbenefits.com. (Note: The benefits provided under a coverage level will be very similar across carriers, but there could be some differences.)

What to Do
If you need help deciding:

  • See how other people rate their health carriers on NMGbenefits.com anytime. Share your own ratings and opinions with others too.
  • Compare the details, when you enroll online, by checking the boxes next to medical options you want to review and clicking Compare (under the check marks). That makes it easy to see which carrier is offering you the best deal. (You may also find Summaries of Benefits and Coverage for comparison on NMGbenefits.com.)
  • Browse the carrier preview sites to learn about programs, tools, and other considerations that could influence your decision.

Ready to enroll? Find out how.

Make It Yours To Go