How to Choose
the Right Health Plan

If your employer has offered you a selection of plans to choose from, and you are unclear about which one is right for you, take a look at these pointers ...

The answer is in the details

Most plans provide some variety of basic medical coverage. Whether you have an HMO or straight Fee-for-Service, you'll be covered in the event of an emergency and have someone to call if you come back from your ski trip with a nasty case of bronchitis.

But why settle for coverage that might not be the best for you? The ideal plan covers most of your health coverage needs at the most reasonable cost to you.

First, look for the basics

Find out how a plan handles the following fundamental health care services:

• Office visits
• Hospitalization -- both elective and emergency
• Emergency room treatment
• Hospital Services -- outpatient
• Surgery -- inpatient and outpatient
• Treatment by a specialist
• Prescription drug coverage
• Diagnostic X-ray/lab
• Next, find out about the extras
• Obstetrical or gynecological care
• Mental health counseling and care
• Substance abuse services
• Physical therapy and rehabilitative care
• Home health care
• Skilled nursing facility
• Hospice care
• Chiropractic care
• Private-duty nursing
• Maternity care
• Well-baby care
• Durable medical equipment
• Vision care
• Dental services

Narrowing your choices down even more

When you choose a plan, you will undoubtedly have to make a few concessions. Maybe you'll pay a little more out-of-pocket to have the flexibility and scope of coverage you want, or the ability to go to any doctor. Or perhaps you'll give up a few plan benefits in order to enjoy a lower monthly premium or smaller copay. As you pare down your options, ask yourself the following questions:

• Am I healthy?
  If you are reasonably fit, you will not be spending as much time with a doctor as someone who manages a chronic health condition like heart disease, high blood pressure or diabetes. For you, annual screenings and emergency care will be your insurance priorities.
  
• Do I want limits on my choice of doctors or hospitals?
  Can't stand for someone else to be in control? Perhaps an HMO is not your first choice. (Remember, HMOs require a primary care physician and confine your ability to choose the doctor of your choice.)
  
• How convenient does my care need to be?
  Don't mind traveling across town to a managed care facility where most services are conveniently located in one place? Then a staff-model HMO is worth looking into. Absolutely need to be able to see your favorite private practice physician down the street? You'd better look at a plan that includes your doctor in their provider network.
  
• How important is the cost of services?
  If your employer offers a choice of plans, make sure to study them carefully. You may be required to pay copays, coinsurance or prescriptions out-of-pocket. Consider the plan that is easiest on your wallet.
  
• How do I feel about keeping receipts and filing claims?
  Obsessively organized? Then the paperwork involved with most Fee-for-Service plans probably won't bother you. If, however, you can barely make a pathway from your door to your desk, you might prefer a less form-intensive plan, like an HMO. (Take note: If you lose receipts or fail to turn in forms, your claims will not be paid.)
  
• Do I or my family members have a chronic health condition?
  If you or a loved one requires continual medical attention, consider your health plan very carefully. How much can you afford to spend on your condition? How convenient is the treatment facility? Do you want the freedom of choosing your own specialist?
  
• Will I or a family member be traveling extensively or spending a significant amount of time away from home?
  Make sure you understand the out-of-town rules on your choice of plans.

Don't forget to tally the potential costs to YOU

To get a realistic idea of what your costs will be for each plan, take a look at how much you will pay for your premium, deductibles, copays and other costs. Check out the following:

• Must you pay deductibles before the insurance begins to cover your care? How much are these deductibles?
  
• After you've met a deductible, what part of your medical costs are paid by the health plan? Does this amount vary by the type of service, doctor or health facility used?
  
• Must you pay copays for doctor visits?
  
• If you use an out-of-network doctor, how much will you have to spend?
  
• If a plan does not cover certain services or care that you think you will need (like a yearly gynecological exam, for example) how much will you have to pay to get the service?
  
• Are there limits to how much you must pay in the case of a catastrophic illness?
  
• What is the yearly or lifetime limit on how much the plan will pay for your care?

Ready to choose a doctor? Here's the right prescription ... >> click here