|
|
In choosing a plan,
you have to decide what is most important to
you. All plans have tradeoffs. Ask yourself
these questions:
· How comprehensive do I want coverage
of health care services to be?
· How do I feel about limits on my choice
of doctors or hospitals?
· How do I feel about a primary care
doctor referring me to specialists for additional
care?
· How convenient does my care need to
be?
· How important is the cost of services?
· How much am I willing to spend on premiums
and other health care costs?
· How do I feel about keeping receipts
and filing claims?
You might also want to think about whether the
services a plan offers meet your needs. Call
the plan for details about coverage if you have
questions.
Consider:
· Life changes you may be thinking about,
such as starting a family or retiring.
· Chronic health conditions or disabilities
that you or family members have.
· If you or anyone in your family will
need care for the elderly.
· Care for family members who travel
a lot, attend college, or spend time at two
homes.
Comparing
Health 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 (see section 6.).
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.
· Are there deductibles you must pay
before the insurance begins to help cover your
costs?
· After you have met your deductible,
what part of your costs are paid by the plan?
· Does this amount vary by the type of
service, doctor, or health facility used?
· Are there copayments you must pay for
certain services, such as doctor visits?
· If you use doctors outside a plan's
network, how much more will you pay to get care?
· If a plan does not cover certain services
or care that you think you will need, how much
will you have to pay?
· Are there any limits to how much you
must pay in case of major illness?
· Is there a limit on how much the plan
will pay for your care in a year or over a lifetime?
A single hospital stay for a serious condition
could cost hundreds of thousands of dollars.
You can't know in advance what your health care
needs for the coming year will be. But you can
guess what services you and your family might
need. Figure out what the total costs to your
family would be for these services under each
plan.
Tips on Choosing a Doctor
Your doctor will be your partner in care, so
it is important to choose carefully from the
doctors available to you. In some managed care
plans, you will generally be limited to choosing
from only certain doctors; in other plans, some
doctors may be "preferred," which
means they are part of a network and you will
pay less if you use them. Ask your plan for
a list or directory of providers. The plan may
also offer other help in choosing.
You can ask doctors you know, medical societies,
friends, family, and coworkers to recommend
doctors. You may also contact hospitals and
referral services about doctors in your area.
Once you have the names of doctors who interest
you, make sure they are accepting new patients.
Here's how to check doctors out:
· Ask plans and medical offices for information
on their doctors' training and
experience.
· Look up basic information about doctors
in the Directory of Medical Specialists,
available at your local library. This reference
has up-to-date professional and biographic information
on about 400,000 practicing physicians.
· Use "AMA Physician Select,"
which is the American Medical Association's
free service on the Internet for information
about physicians (http://www.ama-assn.org/aps/amahg.htm).
You may also want to find out:
· Is the doctor board certified? Although
all doctors must be licensed to practice medicine,
some also are board certified. This means the
doctor has completed several years of training
in a specialty and passed an exam. Call the
American Board of Medical Specialties at 800-776-2378
for more information.
· Have complaints been registered or
disciplinary actions taken against the doctor?
To find out, call your State Medical Licensing
Board. Ask Directory Assistance for the phone
number.
· Have complaints been registered with
your State department of insurance? (Not all
departments of insurance accept complaints.)
Ask Directory Assistance for the phone number.
Once you have narrowed your search to a few
doctors, you may want to set up "get acquainted"
appointments with them. Ask what charge there
might be for these visits, if any.
Such appointments give you a chance to interview
the doctors-for example, to find out if they
have much experience with any health conditions
you may have.
|
