How do I compare health insurance policies?
One of the most difficult parts of finding health insurance coverage is comparing policies and determining which best suits your needs. If you find yourself faced with this daunting task, consider the following to help you make the comparison:
Is there a specific physician you want? Many health-care plans require you to remain within a specified network of physicians. If there is a physician you are currently seeing and are comfortable with, you should first check to see whether this doctor is included in the plan you are considering. If not, then peruse the network of physicians available with the plan. You can even research their credentials by calling the medical office or checking with the American Medical Association. You might also research the availability of other doctors you currently use besides your primary care physician, such as an OB/GYN.
Do you have a need for specialized medical care? You will want to find out whether you will always need to contact your primary care physician first in order to get a referral to a more specialized doctor. Or if you are already using a specialist, you might check to see whether this specialist is in the network for the health care plan you are considering.
Do you have a pre-existing condition? If you have a current medical condition, you will want to ensure that this condition will be covered with the health care plan package you purchase. These conditions can vary between plans, from being excluded by one to being fully covered by another. The Health Insurance Portability and Accountability Act (HIPAA) ensures coverage for pre-existing conditions if you are joining a new group plan from your employer and you were insured the previous12 months.
What kind of emergency care is covered? You will definitely need to research which ERs and hospitals are covered in your plan and what constitutes an emergency for that specific plan. You will also want to understand whether you need to contact your primary care physician prior to receiving emergency care.
What types of routine health examinations are covered? Most managed health care plans cover annual health exams, but some independent plans do not. You will want to research what types and how many exams are included in your plan and, if you have children, whether the well-baby checkups and immunizations are also covered.
What kind of prescription drug coverage is included? If you already use prescription drugs on a regular basis, you might consider a plan with good prescription drug coverage. This coverage type varies greatly from one plan to the next. If generic prescriptions are not an option, you’ll want to understand what price you will have to pay for your prescriptions.
What additional services are included? When comparing health insurance plans, you will also want to consider what additional services, if any, are covered. Examples include: Drug and Alcohol Rehabilitation, Mental Health Care, Counseling, Home Health Care, Nursing Home Care, Hospice, Experimental Treatments, Alternative Treatments and Chiropractic Care.
What can you afford? You will most certainly want to compare costs of health care plans, understanding what deductibles you will need to pay first before the health care dollars kick in, what percentage the insurer will pay after the deductible, what your co-payments are, whether there are any lifetime limits on services, and more.
Are there any exclusions? Finally, you will want to review each plan to understand the exclusions or what items are not covered to see whether any condition you currently have or even expect to have is included on that list.