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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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