| What
Is Most Important to You in a Health Insurance Plan?
In choosing
a health insurance plan, you have to decide what is most important
to you. All plans have tradeoffs. Ask yourself these questions:
- How
comprehensive do you want coverage of health care services
to be?
- How
do you feel about limits on your choice of doctors or hospitals?
- How
do you feel about a primary care doctor referring you to
specialists for additional care?
- How
convenient does your care need to be?
- How
important is the cost of services?
- How
much are you willing to spend on health insurance premiums
and other health care costs?
- How
do you feel about keeping receipts and filing claims?
You might
also want to think about whether the services that a health
insurance plan offers meet your needs. Call the plan for details
about coverage if you have questions. Consider:
- Life
changes you may be thinking about, such as starting a family
or retiring.
- Chronic
health conditions or disabilities that you or family members
have.
- If
you or anyone in your family will need care for the elderly.
- Care
for family members who travel a lot, attend college, or
spend time at two homes.
What
Health Insurance Plan Benefits Are Offered?
Most health
insurance plans provide basic medical coverage, but the details
are what count. The best plan for someone else may not be
the best plan for you. For each plan you are considering,
find out how it handles the following:
- Physical
examinations and health screenings.
- Care
by specialists.
- Hospitalization
and emergency care.
- Prescription
drugs.
- Vision
care.
- Dental
services.
- Care
and counseling for mental health.
- Services
for drug and alcohol abuse.
- Obstetrical-gynecological
care and family planning services.
- Ongoing
care for chronic (long-term) diseases, conditions, or disabilities.
- Physical
therapy and other rehabilitative care.
- Home
health, nursing home, and hospice care.
- Chiropractic
or alternative health care, such as acupuncture.
- Experimental
treatments.
- What
preventive care is offered, such as shots for children?
- What
health screenings are given, such as breast exams and Pap
smears for women?
What
Are the Health Insurance Costs?
No health
insurance plan will cover every expense. To get a true idea
of what your costs will be under each plan, you need to look
at how much you will pay for your health insurance premium
and other costs.
- Are
there deductibles you must pay before the health insurance
begins to help cover your costs?
- After
you have met your health insurance deductible, what part
of your costs are paid by the plan?
- Does
this amount vary by the type of service, doctor, or health
facility used?
- Are
there co-payments you must pay for certain services, such
as doctor visits?
- If
you use doctors outside a plan's network, how much more
will you pay to get care?
- If
a health insurance plan does not cover certain services
or care that you think you will need, how much will you
have to pay?
- Are
there any limits to how much you must pay in case of major
illness?
- Is
there a limit on how much the plan will pay for your care
in a year or over a lifetime? A single hospital stay for
a serious condition could cost hundreds of thousands of
dollars.
You cannot
know in advance what your health care needs for the coming
year will be. But you can guess what services you and your
family might need. Figure out what the total costs to your
family would be for these services under each health insurance
plan.
Location
of Services
- Where
will you go for care?
- Are
these places near where you work or live?
- How
does the plan handle care when you are away from home?
Limitations
on Services
Look at
the services offered by each health insurance plan.
- What
services are limited or not covered?
- Is
there a good match between what is provided and what you
think you will need? For example, if you have a chronic
disease, is there a special program for that illness?
- Will
the plan provide the medicines and equipment you may need?
Find out
what types of care or services the plan will not pay for.
These are usually called exclusions.
Few indemnity
and managed care plans cover treatments that are experimental.
Ask how the plan decides what is or is not experimental. Find
out what you can do if you disagree with a plan's decision
on medical care or coverage.
Compare
Health Insurance Plans
After
you review what benefits are available and decide what is
important to you, you can compare plans. Many things should
be considered. These include services offered, choice of providers,
location, and costs. The quality of care is also a factor
to think about.
 
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