How
do I pick a health plan?
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
Ive met my deductible, what percentage of my medical expenses
are reimbursed?
How much
less am I reimbursed if I use doctors outside the insurance companys
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 companys network? ( For dental
plans click here.)
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 Im 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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