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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 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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