How do I pick a health plan?
05-09-2007
 | If
your employer gives you a choice of plans or you need to purchase
your own coverage, it is crucial that you understand your health
insurance choices and pick the insurance that is best for you and
your family.
Here are some questions you should ask yourself
when choosing a health insurance plan: |
| How affordable is
the cost of care?
- What is the monthly
premium I will have to pay?
- Should I try to insure
most of my medical expenses or just the large ones?
- What deductibles will I
have to pay out-of-pocket before insurance starts to reimburse me?
- After I’ve met my
deductible, what percentage of my medical expenses are reimbursed?
- How
much less am I reimbursed if I use doctors outside the insurance
company’s network?
|
| Does
the insurance plan cover the services I am likely to use?
- Are the doctors,
hospitals, laboratories and other medical providers that I use in the
insurance company’s network?
- If I want to use a doctor
outside the network, will the plan permit it?
- How easily can I change
primary-care physicians if I want to?
- Do I need to get
permission before I see a medical specialist?
- What are the procedures
for getting care and being reimbursed in an emergency situation, both
at home or out of town?
- If I have a preexisting
medical condition, will the plan cover it?
- If I have a chronic
condition such as asthma, cancer, AIDS or alcoholism, how will the
plan treat it?
- Are the prescription
medicines that I use covered by the plan?
- Does the plan reimburse
alternative medical therapies such as acupuncture or chiropractic
treatment?
- Does
the plan cover the costs of delivering a baby?
|
 | What
is the quality of the insurance plan I’m looking at?
- How have independent
government and non-government organizations rated the plan? For
example, the National Committee for Quality Assurance (
http://www.ncqa.org
) issues a Consumer Assessment of Health Plans (CAHPS) report for
every medical plan and facility.
- What kind of accreditation
has the plan received from groups such as NCQA or the Joint
Commission on Accreditation of Healthcare Organizations (JCAHO) (
http://www.jcaho.org
)?
- How many patient
complaints were filed against the plan last year and how many were
upheld by state regulatory agencies like the state insurance
commission or the state medical licensing board?
- How many members drop out
of the plan each year? State insurance departments keep track of
“disenrollment rates.”
- Do the doctors, pharmacies
and other services in the plans offer convenient times and locations?
- Does the plan pay for
preventive health care such as diet and exercise advice,
immunizations and health screenings?
- What do my friends and
colleagues say about their experiences with the plan?
- What
does my doctor say about his or her experience with the plan?
|
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