How to Evaluate Health
Insurance Plans
After you review what benefits are available and
decide what is important to you, you can compare plans. Many things
should be considered. These include services offered, choice of
providers, location, and costs. The quality of care is also a factor
to think about.
Services
Look at the services offered by each plan. What services
are limited or not covered? Is there a good match between what
is provided and what you think you will need? For example, if you
have a chronic disease, is there a special program for that illness?
Will the plan provide the medicines and equipment you may need?
Find out what types of care or services the plan
won't pay for. These usually are called exclusions. Few indemnity
and managed care plans cover treatments that are experimental.
Ask how the plan decides what is or is not experimental. Find out
what you can do if you disagree with a plan's decision on medical
care or coverage.
Choice
What doctors, hospitals, and other medical providers
are part of the plan? Are there enough of the kinds of doctors
you want to see? Do you need to choose a primary care doctor? If
you want to see a specialist, can you refer yourself or must your
primary care doctor refer you? Do you need approval from the plan
before going into the hospital or getting specialty care?
Location
Where will you go for care? Are these places near
where you work or live? How does the plan handle care when you
are away from home?
Costs
No health insurance plan will cover every expense.
To get a true idea of what your costs will be under each plan,
you need to look at how much you will pay for your premium and
other costs.
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