10 Key Considerations When Comparing Health Care Plans

Having to choose between multiple health care plans can be a daunting task. Here are 10 key areas to consider when you need to find the best health care plan for your needs: __1.Your Doctor:__ Some health care plans require you to use their network of doctors. If you currently have a physician that you would like to keep seeing, then check first to see if your doctor is included in the health care plan you are considering. If you need to choose a new doctor from the health care plan consider researching the doctors credentials by calling the medical office she works for or checking with the AMA. Location and availability are other factors to consider when choosing a doctor. Not only check where the doctor is located but you will also want to find out the hours of the facility and see if the doctor is available all of those hours as some doctors work in multiple facilities. __2.Specialists:__ If you have specific medical conditions or believe you may need to use specialists in the future you will want to find out how you will be able to use a specialist. Check to see if you will always need to contact your primary care physician first. You will also want to find out if a current specialist you use is an in-network doctor for the health care plan you are choosing. __3.Pre-Existing Conditions:__ This seems like a no-brainer but sometimes in the confusion of choosing health care plans many forget to confirm that their pre-existing condition will be covered or one just assumes it is. Pre-existing conditions can vary between plans from being excluded to being covered fully and sometimes somewhere in-between like being covered after a specific amount of time. The Health Insurance Portability and Accountability Act ensures coverage for pre-existing conditions if you are joining a new group plan from your employer and you were insured the previous twelve months. __4.Emergency and Hospital Care:__ You will want to find out what emergency rooms and hospitals are covered on your plan. In addition, find out what constitutes an “emergency.” Sometimes your definition of an emergency may not be the same as the health care plan you are considering and it could possibly not be covered. Also, check to see if you need to contact your primary care physician first before getting emergency care. __5.Regular Physicals and Health Screenings:__ If you like getting regular physicals and health screenings you will want to make sure they are covered. Most managed care plans cover these types of screenings yearly, but some independent insurance plans do not cover them at all. Also, if you have children find out if well-baby check-ups and immunizations are covered. __6.Prescription Drug Coverage:__ If you currently use prescription drugs on a regular basis or think you may need to in the future, you will want to consider a plan that has a good prescription drug coverage. This coverage type can vary enormously from plan to plan. Variations can include no coverage at all to complete coverage and everywhere in-between like varying co-pays for different types of drugs. Also, if you cannot get your prescription in a generic form, find out first from the different plans what price you will pay for your prescription. __7.OB-GYN:__ If you regularly see a Obstetrician or Gynecologist, find out if your doctor is covered in the plan you are considering and make sure you review all the same conditions as in point 1. above: The Doctor. Also, if you are considering fertility treatments or will in the future, you will want to see what may be covered as some plans are now including varying types of fertility coverage. And the same goes with pregnancy coverage: find out how much you will have to pay out-of-pocket for pregnancy and birth care if you are pregnant or decide to get pregnant in the future. __8.Additional Services:__ Consider what additional services are covered when comparing health plans. Some examples of additional services that may be important to you include: Drug and Alcohol Rehabilitation, Mental Health Care, Counseling, Home Health Care, Nursing Home Care, Hospice, Experimental Treatments, Alternative Treatments, Chiropractic Care. __9.Costs:__ Now that you know what you want in your health care plan it is time to compare costs. Find out what deductibles you will need to pay first before the health care dollars will kick in. You will also want to know if your deductible needs to be met before any services can be used. Also, find out what percent the health care will pay after your deductible, as well what percent they will pay if you need to use a doctor, hospital, or specialist that is out of network if that is a concern to you. In addition, you will want to know what your co-payments are. Co-payments are the fees you need to pay when visiting your doctor, hospital, or emergency room. Finally, know your limits. Some plans have lifetime limits on how much the health care plan will pay and some have lifetime limits along with yearly limits. __10.Exclusions:__ The last consideration is the exclusions list. You will want to review each plan’s exclusions list to find out what is not covered and to see if any condition you currently have or expect to have in the future, is included on that list.