Kathleen Tracy | HealthGreatness
Learning the ins and outs of health insurance is a lot like learning a new language and translating the nuances can be a challenge when trying to determine what policy to buy. Here are some suggestions on how to cut through the clutter and choose the coverage that best meets your current situation and needs.
Make a check list. While it’s impossible to predict unexpected injuries or sickness, there is a fair amount of medical care you can plan for when choosing the right health insurance policy. For example, if you have close relatives who developed heart disease, then it would be prudent to include preventative services such as cholesterol screening, EKGs, and other cardiac screening tests. If you are nearing 50, it’s time to start getting colonoscopies, especially if colon diabetes runs in your family. If you’re planning on having children, you’ll need maternity coverage. If you experience chronic back pain, you’ll want a policy that includes chiropractic care. There is no one-size-fits-all insurance policy so you need to know the coverage that meets you circumstances and medical history.
Choose a plan type. In general there are three types of plans: health maintenance organizations (HMO), preferred provider organizations (PPO), and point-of-service plans (POS). HMO policies require patients to use doctors in a specific network. In short, you are giving up choice of physician in order to pay less for the insurance. With a PPO you can either stay in-network or go out of network for a higher. Typically, out-of-pocket costs are higher for PPOs than for HMO’s. The POS plans are a cross between HMOs and PPOs: these policies provide the option to pay more for going outside the network, but normally require you to choose a primary care physician within the network. A referral from the primary care doctor is needed in order to consult a specialist should the need arise.
Be prudent. Most people are on a budget so buy the insurance you can afford and that makes sense for your current situation. So, if you are young and healthy it makes more financial sense to get a policy with a higher deductible and lower monthly premium. Also, determine exactly what your out-of-pocket costs are going to be. All plans must clearly state co-pays and coinsurance fees so you have a more complete financial picture.
Know Who Is in the Network. If keeping your current primary care physician or ob\gyn is important to you, confirm they are included in the network of the insurance plan you are considering. The insurance company should be able to provide you with a list or simply call your doctor and ask them what networks they belong to.
Prescriptions. If you have a condition that requires regular medication make sure your drugs are covered in the policy.
Consumer shop. Compare and contrast several policies side by side before making a final decision. Pay particular attention to any cost-sharing features that could end up leaving you footing unexpected bills. Also, take advantage of the Affordable Care Act’s health insurance exchanges. Depending on your situation, the exchanges may have the perfect plan for you at a lower cost than going through a traditional insurance broker or signing up for your employer’s plan.