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How do I choose a health plan?

Diana Meeks
Diana Meeks on behalf of Sigma Nursing
Family Practitioner
When purchasing health insurance you have several options and several factors to consider. If your employer offers a group plan, sign up. This is usually the easiest, least expensive, and most comprehensive way to buy health insurance. If you can"t get employer coverage, you should consider the cost, the company"s reputation through independent rating agencies, and the specific needs of your family, and then research the programs offered by your state or federal programs to see if you are eligible. Read any policy carefully to make sure you understand what coverage you are getting for your money.
Dr. Michael Roizen, MD
Internal Medicine
Health insurance plans come in more flavors than gelato. But luckily for sanity-loving people everywhere, they can all be sorted into four broad categories: indemnity plans (also called fee-for-service plans), point-of-service plans, health maintenance organizations (HMOs), and preferred provider organizations (PPOs). The first two flavors give you, the consumer, lots of options, but at a higher cost. The second two are considered managed care, so you have fewer choices, but the plans tend to be less expensive.
Once you’ve identified which flavor suits you best, give the policy the third degree and figure out:
  • What hospitals and doctors are in the plan’s network? Are the hospitals Joint Commission-accredited? Check to make sure that the Dr. Frank you circled in the book is indeed your Dr. Frank.
  • What’s not covered?
  • What will happen if I get cancer, get pregnant, or become disabled?
  • Can I use an out-of-network doctor, and what will it cost?
  • What percentage of the total cost will I pay for common services and diagnostic procedures such as X-rays or blood tests?
  • If I get extremely sick, how much freedom does my doctor have in coordinating care, and can I see any specialists I want?
  • How much will the plan pay for generic and brand-name prescription drugs?
  • Can I increase my deductible and pay lower premiums?
  • What’s the yearly out-of-pocket limit? (A typical figure is $2,000…don’t let them gouge you!)
  • What is the coverage for mental health?
  • What’s the coverage for alternative therapies, such as chiropractic visits and acupuncture?
  • Will follow-up care, such as nursing-home or home-health care, be covered?
  • If I have a serious medical problem, will the plan provide someone to oversee care and make sure my needs are met?
  • Which specific conditions or injuries does the plan deem as emergencies requiring urgent care?
  • If I’m in a foreign country and have an emergency, will this plan pay to evacuate me at my request? (This one isn’t a must, but it’s a nice bonus -- plus, it can’t hurt to mention that you’re accustomed to flying first class.)
Based on the answers to those questions and how they compare to your needs, you should be able to find a plan that fits you as well as Cinderella’s glass slipper fits her.
Donna Hill Howes, RN
Family Medicine
When it comes to health plans, not everyone has a choice. But if you do, you will need to understand how different plans affect your choice of providers and services, costs, and quality of care. This information can be confusing. Few people understand their options well enough to make an informed choice.

This answer is based on source information from the National Women's Health Information Center.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.