By Dr. Darcey M. Winterland and Diane Bennett | Thoughts on Innovation
As open enrollment begins, families across Arizona face one of the most important decisions of the year: selecting a health insurance plan.
With rising premiums, complex coverage structures and limited provider networks, the process can feel overwhelming. Yet the stakes could not be higher, especially for households with children. Ensuring young patients have access to comprehensive pediatric care should be a top priority in every health plan decision.
Rising Costs, Limited Options
Families are feeling the squeeze as insurance companies continue to post double-digit rate increases. These higher premiums add to the burden of higher co-pays, deductibles and coinsurance. In Arizona, the challenge is compounded by a marketplace where several major insurers have exited in recent years, narrowing choices for local families.
While it may be tempting to select a plan based solely on premium costs, doing so without closely reviewing coverage details can result in costly gaps in care. For families managing chronic pediatric conditions like asthma, ADHD or diabetes — or simply preparing for the inevitability of unexpected injuries such as broken bones or sprains — these gaps can be both financially and emotionally devastating.
Why Pediatric Coverage Matters
Children’s healthcare needs differ from those of adults. A single sports injury, for example, can involve a chain of care including imaging, potential outpatient surgery, physical therapy and follow-up visits. Likewise, conditions such as allergies, behavioral health concerns or developmental delays may involve ongoing medication, therapies and specialist intervention. Without a plan that includes robust pediatric coverage, the cost of care can escalate quickly.
Families should not only consider immediate needs but also anticipate the potential for unexpected or long-term conditions. Comprehensive pediatric coverage ensures access to primary care, urgent care, specialty services and hospital care.
When evaluating health plan options, families should keep several important factors in mind:
Provider Networks: Make sure your child’s pediatrician and any specialists your family sees regularly are in-network. While narrow networks may reduce premiums, they can lead to significant costs if out-of-network care becomes necessary.
Hospital and Clinic Access: Confirm your preferred hospitals and pediatric specialty clinics are in-network. For Arizona families, inclusion of Phoenix Children’s and the Phoenix Children’s Care Network (PCCN) is particularly important. PCCN encompasses more than 1,175 pediatric providers across many subspecialties, offering a continuum of care designed for young patients.
Prescription Drug Coverage: Review the formulary carefully, ensuring maintenance and emergency medications are covered. This is especially important for families managing chronic conditions that require ongoing prescriptions.
True Cost of Care: Go beyond monthly premiums to evaluate deductibles, co-pays and co-insurance. In some cases, a higher monthly premium may provide more comprehensive benefits and lower overall costs.
Out-of-Network Coverage: Understand the plan’s policies for out-of-network services. While some plans may offer limited benefits, others provide little to no coverage, potentially resulting in significant out-of-pocket expenses.
Added Value Benefits: Look for plans that include tax-advantaged options such as Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs), as well as wellness programs and care coordination services. These extras can make a meaningful difference in your family’s healthcare experience and long-term outcomes.
Making an Informed Decision
Selecting the right health plan requires more than comparing premiums; it requires careful consideration of how the plan supports your family’s specific health needs — both routine and extraordinary. Parents should take time to thoroughly compare options, contact providers to confirm network participation and seek guidance when needed.
Open enrollment presents an opportunity to secure peace of mind for the year ahead. By prioritizing pediatric coverage, families can ensure their children receive the care they need without unnecessary financial strain. Comprehensive insurance is not just a safeguard against high medical bills; it is an investment in the long-term health and well-being of Arizona’s next generation.
Editor’s Note: Dr. Darcey M. Winterland is co-medical director of Phoenix Children’s Pediatrics and Dianne Bennett is Interim Chief Nursing Executive and Senior Vice President of Patient Care Services at Phoenix Children’s.
