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5 Tips to Help You Choose a Better Health Plan

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It is a wonderful time of year for those who sell advertising space in newspapers, on billboards, bus boards, television and radio as it is once again open enrollment time for our health insurance companies.   We are inundated with cute slogans as well as print advertisements running across the country from health insurers who are trying to influence our decision by taking a stand on the national health debate before congress.  For the insurers the financial stakes are always very high.  For us however the stakes are much higher. Sure, our choice has monetary implications, but more importantly we need to select the plan that will provide us with the best coverage for our personal situation in the coming year.

Most people don’t pay much attention to the benefits of their health insurance plan until it becomes absolutely necessary.  As you follow the adventures of my family you know that we have unfortunately become experts in not only what is covered but how to work the system.  In the beginning though we were like everyone else who made the mistake of trying to decipher our coverage in a crisis situation. The upside is now I can guide others on what I learned from my own mistakes.

The hardest time to make important decisions is when your mind is not clear and there is so much at stake.  Whether you are staying with your current provider, making a change, or receiving coverage for the first time, it is critical to understand costs, benefits and ultimately what will work best for you, your family and anyone else you may be responsible for caring for.   Empower yourself with knowledge.  In preparation, gather your information and organize it.  In other words “compile it and file it.”

Make sure your doctors and hospitals are covered by your plan of choice.  Learn what types of services are routinely covered and what is excluded.  Consider your coverage for routine physical exams, specialists, hospitalization, emergency care, dental, vision and prescription drugs.  Other areas of coverage to explore include mental health, obstetrical/gynecological care, rehabilitation, home health services, long-term care, and hospice care, services for drug and alcohol abuse and alternative medicine (chiropractic / acupuncture).  Finally, can you see doctors who are “out of plan?”

Evaluate the health needs of your family before deciding on a specific plan.  Are there major life changes expected such as starting a family, retiring or a child starting college?  Do you or a family member have a chronic health condition requiring coverage for any special programs, medications, or equipment?   Title I of The Health Insurance Portability and Accountability Act (HIPPA) will ensure that a pre-existing condition is covered by a group health plan without a waiting period if you have been continuously insured for the previous twelve months without a significant break in coverage for 63 days or more.   Be sure you understand “the exclusions” - what is not paid for.  How much choice will you have in picking a primary care physician and what is the procedure to see a specialist?

Use these health organizing tips when compiling information to help you choose your health plan:

  1. When comparing plans, compare the costs for routine doctor visits, specialists, emergency room visits and when you need to be admitted to a hospital.
  2. Compare the required out of pocket costs for prescription drugs and whether they offer an option to order medications at reduced cost by mail.  Make sure to investigate less costly generic drugs.
  3. Evaluate if doctors and other medical services are conveniently located to where you work and live and how the insurance works when you are away from home.
  4. Ascertain if preventive health care is offered, including flu or pneumonia shots, or screening for breast health.
  5. Find out how the plan determines if a treatment is experimental and what the procedure would be if you needed the treatment.

You are getting into shopping mode for the holidays so just add “find the best health insurer” to your list!

Last Updated:11/30/2009
Important:The views and opinions expressed in this article are those of the author and not Everyday Health.
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Date: 16.12.2018, 00:12 / Views: 61395