How to Choose a Health Insurance Plan

by Staff Expert

Introduction

These days, landing in the hospital for even a few days can decimate your savings account. That's why it's extremely important to consider the cost, the benefits, and the extent to which your family's health needs are met when choosing insurance. Research the various plans that are available, and determine how specifically tailored they are to your family's health needs and financial abilities, to decide on a plan that is best suited to your lifestyle.

Instructions

Difficulty: Moderate

Step One

Sign on with the health insurance provided by your employer: It is likely to be the cheapest option you can find. Your employer's carrier may have more than one option for you to choose from (HMO, preferred). If you're self-employed or if your company doesn't offer insurance, you'll have to search for your own insurance.

Step Two

Assess your needs, taking into account your current use of health care and your medical expenses for the near future, and decide what services are most important to you and your family. Ask about dependents' coverage. Factor in how much you can afford to spend on monthly premiums and co-payments. If you're single and healthy, your health plan needs will be very different from those of a family with three young children.

Step Three

Compare benefits and coverage of key items like monthly premiums, deductibles, co-payments, co-insurance rates, costs for seeing out-of-network providers, preventive care, physical exams, immunizations and the like. Other services that are of interest to your family could include fertility services, mental health coverage, nursing care and long-term care.

Step Four

Ask lots of questions: Are your current providers part of this plan? Do you need referrals for specialist visits? How easy is it to change doctors? What hospitals and facilities can you use as part of the plan? What are the procedures for having emergency room treatment approved?

Step Five

Find out if benefits are limited for preexisting conditions, or if you have to wait for a period of time before you're fully covered. Some plans may completely exclude coverage of preexisting conditions.

Step Six

Research whether there is a fair appeals process available if the company denies treatment, and if these appeals are reviewed by an external, independent agency. Is there a high turnover rate among doctors in the plan? Check if the National Committee for Quality Assurance (NCQA.org) accredits the plan; the Pacific Business Group on Health (HealthScope.org) also offers information on health plans.

Step Seven

Pick a plan that best matches your needs and priorities based on thorough research. Read all materials and call the health plan representative or conduct Internet research to get any information you are missing. Discuss pre-existing conditions and flexspending plans before making a decision.

Step Eight

Investigate long-term care insurance. The rising cost of health care and elderly care can demolish your savings if you are incapacitated for long. The best time to buy it is when you hit your 40s.

Overall Tips & Warnings

• If you're switching plans through your employer, ask when the next open enrollment period will occur. Give yourself at least two months in which to conduct and complete your research of health care options.

• If your employer doesn't provide health insurance, investigate professional associations that offer members the opportunity to join a health plan.

• Take into consideration any upcoming medical expenses, such as surgery, dental work or a new baby.

• Take convenience into consideration: Will you have to file claim forms? How close are doctors, hospitals and pharmacies to your home? How often are you permitted to change doctors? Ask if a telephone nurse advice line is offered, particularly if you have young children who tend to get sick at odd hours.

• Find out if the plan you're reviewing surveys its members to determine how satisfied they are with the services provided. If it does, ask for the information. See how member satisfaction rates. You should also take note of whether the plan offers a toll-free number for assistance. Test it out before you join.

• Ask your primary care physician how easy it is to get referrals for specialists on certain plans. He or she can also tell you how easy it is to find a specialist, which hospitals and types of preventive care the plan covers, and what the claims and utilization review process is like.