A Few Months In: Are You Using Your Health Plan?

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We are a few months into the year, which makes this a good time to pause and take a closer look at how you are using your health plan.

Whether you selected new coverage this year or have been on the same plan for a while, this is often when expectations meet reality. You may have filled a prescription, visited a provider, received a bill, or you may not have used your plan at all.

Wherever you are, now is a good time to check in.

Are you actively using your benefits, or are you only thinking about your plan when something comes up? Health insurance is often treated as something you deal with when you need care, but it is meant to be used throughout the year.

Some questions to ask yourself:

  • Have you scheduled your annual wellness visit?
  • Are you using in-network providers?
  • Do you know what your copay is and whether you have coinsurance? Do you understand the difference between the two?
  • Do you know how much of your deductible you have met?
  • Do you understand what services are considered preventive care?
  • Do you know where to go depending on the situation, such as telehealth, urgent care, or the emergency room?

If any of these are unclear, you are not alone. Many people do not fully understand their coverage until they need to use it.

One area that is often overlooked is preventive care. Routine exams, screenings, and labs are often covered at little to no cost when done in-network. Taking care of these early can help you stay ahead of potential health issues.

If you have already used your plan this year, your claims can give you a clearer picture of how your costs work. This includes how your deductible applies and what your copays look like.

Small decisions can affect your costs. Where you go for care, whether a provider is in-network, and whether you ask questions ahead of time can all impact what you pay. Before your visit, consider asking about expected costs, whether prior authorization is required, and whether the service will be considered preventive or diagnostic. Writing your questions down in advance can help you feel more prepared and confident in your decisions.

If you have not spent much time thinking about your health plan yet, that is okay. There is still plenty of time to make the most of it.

Start by taking a look at your plan details, such as your Summary of Benefits or plan documents, so you understand what is covered and how your costs are structured. It can also be helpful to check your progress by seeing how much of your deductible you have met and where you stand in relation to your out-of-pocket maximum.

Scheduling preventive care is one of the easiest ways to use your benefits and stay on top of your health. If you expect to need services later this year, take time to plan ahead by confirming providers and facilities in advance, making sure they are in-network, and understanding what your costs may be.

Your health plan is something you can use to support your health and make more informed decisions about care. Taking a few minutes now to understand how your plan is working can help you avoid surprises and feel more confident in your choices throughout the year.

 

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Practical Wellness Tips for a Busy Holiday Season

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The holidays are supposed to be about celebration and connection, and some rest (hopefully). But the month of December often feels more like a marathon to get places and check off your never-ending “to-do” list. Between work deadlines, family obligations, travel, and a social calendar that somehow fills itself, the whole season can start to feel overwhelming instead of joyful.

If you’re trying to balance your job, personal life, and a budget that’s getting stretched thin, you’re not alone. A few simple habits can help you get through the season without burning out.

Aim for some balance when it comes to eating and your health. One of the biggest traps this time of year is thinking you need to be super disciplined about health. Small tweaks matter more than you’d think. Grab a protein-rich snack before heading to the party because it will help keep your energy steady and help you avoid overindulging at the party! Drink more water than you think you need, especially if you’re traveling or celebrating. And after a big meal, even a quick 10-minute walk can help your digestion and lift your mood.

Don’t sacrifice sleep. Late nights and early mornings are basically the norm in December. Sleep is one of your best defenses against stress, brain fog, and getting sick. Try to keep your sleep schedule consistent and give yourself a wind-down routine – do some stretching, journal for a few minutes, or put your phone away earlier than usual.

Build in breathing room. Between the gatherings and the pressure to make everything perfect, stress can pile up fast. Taking five minutes to step outside, taking some deep breaths, or sitting quietly can reset your nervous system and support your overall well-being. Mindfulness doesn’t have to be complicated. Sometimes it’s just noticing your breath or feeling your feet on the ground.

Move your body. Exercise in December doesn’t need to be a formal workout. Take a walk around the neighborhood to check out the holiday lights. Stretch between work calls. Choose to take the stairs. These little moments of movement do help—they keep your energy up, lower stress, and improve your sleep and mood.

It’s fine to scale back. There tends to be the expectation that you’re supposed to do it all – attend every event, uphold every tradition, make everyone happy. Remember – it’s okay to say no, to skip things, to protect some time for yourself. The parts of the season that matter most are the ones you have the energy to enjoy.

The holiday season doesn’t have to overwhelm you. With a bit of intention and some realistic expectations, you can end the year feeling good about being grounded, present, and ready for whatever comes next.

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CalCPA Health Podcast Episode 3 – Navigating Health Info & Speaking Up (Dianne Pulleyblank)

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Misinformation is everywhere—and navigating the healthcare system can feel like a second job. This episode is about empowering listeners to cut through the noise. Learn how to identify trustworthy health sources, prepare for medical appointments, and advocate effectively for your needs. We’ll also share tips on having tough conversations with doctors and pharmacists.

Topics Covered:

    • How to spot credible health news
    • Red flags in medical misinformation
    • Preparing for appointments (health journaling, family history)
    • Patient-provider communication strategies
    • Questions every patient should ask
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CalCPA Health Podcast Episode 2 – Heart in Motion (Dianne Pulleyblank)

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In this energizing episode, we dive into the science behind cardiovascular health and the essential role of movement in protecting your heart. We’ll break down how different forms of cardio benefit your circulatory system, boost your mood, and increase longevity. Whether you’re already active or just starting out, you’ll gain actionable tips to build a heart-healthy routine that works for you.

Topics Covered:

  • How cardio strengthens your heart
  • Debunking fitness myths
  • Everyday ways to get your heart rate up
  • Motivation for consistency
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CalCPA Health Podcast Episode 1 – The Journey to Healthy Habits (Dianne Pulleyblank)

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This episode kicks off your journey toward healthy living. We’ll explore how to build sustainable habits, set realistic goals, and shift limiting belief systems. Learn how to use time management, habit stacking, and the power of small wins to drive lasting change. This motivational episode includes reflection prompts to help listeners take control of their health-starting with that first step.

Topics Covered:

  • The psychology of change and behavior
  • Habit stacking & micro-goals
  • Overcoming common barriers
  • The role of belief systems
  • Reflective journaling prompts for listener
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New for 2026: Alternative Health Plans

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It’s on every headline in the newspaper and on the news – healthcare costs in the U.S. continue to rise sharply. It is affecting the entire country, and there seems to be no end in sight to the continued rise in costs. In 2023, national healthcare spending surged 7.5% to $4.9 trillion, accounting for 17.6% of U.S. GDP[1] [2]. That’s nearly one-fifth of the economy, and it’s projected to rise even higher in the years ahead.[3]

Prescription drug costs alone rose 11.4% in 2023, resulting in drugs now making up 9.2% of total health spending [4]. According to PWC, “Drug spending in the US grew by $50 billion (11.4%) from $437 billion to $487 billion in 2024 at net manufacturer prices, up from $20 billion of growth (4.9%) in 2023. The trend is expected to extend into the coming years, driven by growth in oncology, immunology, cardiovascular, obesity, and diabetes drugs.”

New for 2026: Copay-Only Alternative Health Plans (AHPs)

To help employers manage rising costs and expand plan options, CalCPA Health is introducing a suite of Alternative Health Plans (AHPs) through Anthem Blue Cross, powered by Coupe Health™. These tiered, copay-only PPO designs emphasize clarity, quality, and cost control, with no gatekeeper required. Members can view provider tiers and their out-of-pocket costs before scheduling care, which enables smarter, value-driven decisions that can lead to savings for both employers and employees.

While AHPs are not new, CalCPA Health’s offerings stand out by including Small Group and HSA-compatible options—a rare find in the market. Learn more about these plan offerings and search for in-network healthcare providers.

Benefits for Employees

  • No deductibles* or coinsurance on most plans.
  • Access to California’s largest provider network – Anthem Blue Cross.
  • Cost transparency tools to view provider rankings and exact costs upfront.
  • Tiered provider rankings highlight quality and value.
  • Comprehensive coverage of ACA essential health benefits: including preventive care, hospital/urgent/emergency services, specialty care, pharmacy, maternity, behavioral health, and more.

Benefits for Employers

  • Premium savings potential, thanks to more efficient plan design and guiding members to high-performing providers.
  • Smarter employee healthcare choices—when costs are visible before care, usage aligns with value.
  • Plans that align with expectations—transparency, convenience, and choice.
  • Improved employee retention by offering flexible, cost-effective options.

With healthcare spending and pharmacy costs continuing to rise, firms seek innovative, value-driven approaches rather than traditional plans with higher price tags. CalCPA Health’s AHPs offer CalCPA member firms a compelling alternative: Anthem’s provider network, combined with Coupe Health’s™ cost-transparency capabilities. These plans deliver what today’s market is looking for: affordability, clarity, quality, and flexibility.

*Two AHPs are HSA-compatible HDHPs, which do include a deductible.

 

[1] https://www.pgpf.org/article/healthcare-spending-will-be-one-fifth-of-the-economy-within-a-decade

[2] https://www.reuters.com/business/healthcare-pharmaceuticals/us-healthcare-spending-rises-48-trillion-2023-outpacing-gdp-2024-06-12/

[3] https://www.pgpf.org/article/healthcare-spending-will-be-one-fifth-of-the-economy-within-a-decade

[4] https://www.chcf.org/resource/national-health-spending-almanac

 

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It’s Open Enrollment: What You Need to Know

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Open Enrollment is the annual opportunity to review your health insurance options and make changes for the upcoming year. For most of us —whether employers, solo practitioners, or employees —open enrollment typically occurs in the fourth quarter, and new benefits take effect on January 1st of the new year.

This period is especially important because outside of open enrollment, you can only make changes to your coverage if you experience a qualifying life event (such as marriage, divorce, birth of a child, or loss of other coverage). That means this is your chance to:

  • Reevaluate whether your current plan still meets your needs.
  • Compare costs and coverage options, including PPOs, HSAs, EPOs, HMOs, or Alternative Health Plans (AHPs).
  • Add or adjust coverage for dependents.
  • Research Health Savings Accounts (HSAs) and the tax-advantaged options these plans provide.
  • As an employer, evaluate your current plan offerings and consider what adjustments may be needed, and if new options are available that would improve employee retention and satisfaction.

Why It Matters This Year

Healthcare costs and coverage trends continue to shift, with rising pharmacy and claim expenses, as well as evolving provider networks. More employers are introducing an array of choices, including innovative alternatives that emphasize transparency and cost savings. Employees may be seeking ways to get the most value from their benefits and manage their premium costs – and know the cost before a visit. (Learn about the new Alternative Health Plans – AHPs – that CalCPA Health is offering for 2026!)

Reviewing your options before open enrollment deadlines is key, so you have enough time to research and understand what’s available to you, your family, and your firm. Becoming your best advocate on health insurance can lead to lower out-of-pocket costs, access to preferred providers, and greater financial protection for the year ahead.

Tips for Open Enrollment Readiness

  • Start early. Don’t wait until the final days of enrollment—give yourself time to compare and select the best plan.
  • Review your healthcare usage. Think about your doctor visits, prescriptions, and family needs over the past year – did you use these benefits?
  • Look at the long term. HSAs, for example, may offer both immediate premium savings and future tax advantages, allowing you to save now for future medical expenses.
  • Ask questions. Your HR team, broker, or plan administrator can help explain plan differences and benefits.

NOTE: CalCPA members can reach out to CalCPA Health with their health insurance benefit questions – whether you are enrolled with us or not – by email info@CalCPAHealth.com or call 866-730-3593.

Open enrollment is an opportunity to align your health coverage with your personal, family, and financial needs. By researching and asking questions, you’ll enter the new year with confidence, knowing you made the best choice available to you.

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Know Where to Go: Doctor, Urgent Care, or ER?

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When you’re sick or injured, knowing where to go for care isn’t always easy — especially when you’re in discomfort and distracted. Knowing how to choose where to go for the right care can save you time, money, and stress.

At CalCPA Health, we believe education is one of the best tools you can use to take charge of your health. Here’s a guide to help you decide when to visit your primary care doctor, head to urgent care, or go to the emergency room, as well as what each might cost under most health plans.

Your Doctor (Primary Care Physician)

Best for: Routine care, chronic conditions, preventive visits, and minor issues during business hours.

Your doctor knows your medical history and can treat you more personally than in other care settings. For non-emergency symptoms like a mild rash, cough, cold, or stomach bug, this is often the best first stop if you can get an appointment. Primary Care Physicians are usually available during normal business hours and may also provide medical advice by phone after hours or even email you.

Typical cost with insurance:
Usually, it is a $$ copay, depending on your plan. *

Virtual Care (Telehealth)

Best for: Cold/flu symptoms, rashes, UTIs, minor infections, allergies, or when you need care quickly but it’s not an emergency.

Telehealth is available 24/7 with Anthem’s Sydney Health app (available to CalCPA Health members) or other virtual platforms. You can see a doctor at your convenience without leaving your home. It’s usually faster and lower cost than in-person visits.

Typical cost:
Often $ copay — check your plan summary for details. *

Retail Clinics (Walk-In)

Best for: Sore throats, earaches, pink eye, minor cuts or burns.

Located in places like CVS or Walgreens, these clinics are staffed by nurse practitioners or physician assistants and are great for quick, simple care when your doctor’s office is closed. This option is usually at a lower cost and wait time than urgent care but may have limited scope.

Typical cost:
Around $$ if self-pay, or your copay if using insurance.*

Urgent Care

Best for: Sprains, strains, minor broken bones, infections, moderate flu symptoms, or nausea that’s not life-threatening.

Urgent care is typically open daily, nights, and weekends, with access to lab tests, X-rays, and treatments not usually available at retail clinics. It’s a good choice when you need attention right away, but it’s not a 911-level emergency. Urgent care visits tend to be faster and more affordable than a visit to the ER.

Typical cost with insurance:
The copay is often $$$, depending on plan and services rendered. *

Emergency Room (ER)

Best for: Serious or life-threatening situations such as chest pain, breathing difficulties, heavy bleeding, signs of stroke, or major trauma.

Emergency Room visits should be reserved for true emergencies and will cost significantly more. They also often involve longer waiting times unless your condition is severe.

Typical cost with insurance: $$$$
ER visits can result in copays plus coinsurance (often a percentage of total charges), unless you’re admitted to the hospital for inpatient care, in which case the ER copay may be waived. *

Things to keep in mind
  • Use virtual care because it is fast, affordable, and covered under most CalCPA Health plans as well as under other carriers.
  • If it’s not urgent and it’s during business hours, check in with your doctor.
  • Going to the ER for non-emergencies leads to higher costs and delays, care for those who have true emergencies.
  • Understand your provider’s Summary of Benefits and Coverage to know your exact copays and coverage rules. (Summary of Benefits and Coverage for CalCPA Health medical subscribers)
  • Be prepared and locate the nearest urgent care or 24/7 virtual care option now before you need it, and make sure that you share the information with your family so that they are ready for different medical situations that may arise.
  • Keep your medical card handy, preferably via a mobile app. CalCPA Health medical members should download the Sydney App if they haven’t done so already.
  • Use the “Find Care” tool to locate in-network providers.
CalCPA Health members have access to:
  • The largest PPO provider network in California through Anthem Blue Cross
  • 24/7 virtual care options
  • One point of contact through our customer support team (Banyan Administrators) to help you with benefits, claims, or locating care

If you’re unsure where to go, call the customer support number on your ID card — they can guide you to the right care setting.

* If you are on an HSA-compatible HDHP, you might have to satisfy your Calendar Year Deductible before the Copay amount applies.

 

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Your Eye Exam Could Save Your Life

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Most people think of an eye exam as a quick check to update their glasses or contact prescription. But it is way more than that.

According to the American Optometric Association (AOA), an eye exam can reveal more than 270 serious health conditions, often before you notice a single symptom. Your eye doctor can detect early signs of such diseases as diabetes, high blood pressure, autoimmune disorders, and even certain cancers. An annual eye exam could be one of the most valuable preventive health screenings available.

During a comprehensive eye exam, your optometrist isn’t just checking your vision. They’re examining your retina, optic nerve, and blood vessels, which can reveal early signs of:

  • Diabetes: changes in tiny blood vessels can appear before other symptoms develop.
  • High blood pressure: narrowing or bleeding in eye vessels can be an early warning sign.
  • Multiple sclerosis: inflammation in the optic nerve may be one of the first indicators.
  • Certain cancers: tumors can sometimes be detected through changes in the eye’s appearance.

The AOA stresses that annual exams are one of the most effective ways to catch health problems early. Many of these conditions, if detected soon enough, can be treated or managed before they cause lasting damage.

Annual exams are important no matter what, but certain changes should prompt an immediate appointment because they can signal medical issues that need attention:

  • Sudden blurry vision
  • Double vision
  • Drooping eyelids
  • Flashes of light or sudden floaters

Your annual eye exam isn’t about just your eyes and your vision; it is about protecting your overall health. If it’s been more than a year since your last appointment, schedule one today.

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