Here are some questions you should ask yourself when choosing a health insurance plan:
How affordable is the cost of care?
- What is the monthly premium I will have to pay?
- Should I try to insure most of my medical expenses or just the
large ones?
- What deductibles will I have to pay out-of-pocket before insurance
starts to reimburse me?
- After I’ve met my deductible, what percentage of my medical
expenses are reimbursed?
- How much less am I reimbursed if I use doctors outside the insurance company’s network?
Does the insurance plan cover the services I am likely to use?
- Are the doctors, hospitals, laboratories and other medical
providers that I use in the insurance company’s network?
- If I want to use a doctor outside the network, will the plan
permit it?
- How easily can I change primary-care physicians if I want to?
- Do I need to get permission before I see a medical specialist?
- What are the procedures for getting care and being reimbursed in
an emergency situation, both at home or out of town?
- If I have a preexisting medical condition, will the plan cover it?
- If I have a chronic condition such as asthma, cancer, AIDS or
alcoholism, how will the plan treat it?
- Are the prescription medicines that I use covered by the plan?
- Does the plan reimburse alternative medical therapies such as
acupuncture or chiropractic treatment?
- Does the plan cover the costs of delivering a baby?
What is the quality of the insurance plan I’m looking at?
- How have independent government and non-government organizations
rated the plan? For example, the National Committee for Quality
Assurance ( http://www.ncqa.org
) issues a Consumer Assessment of Health Plans (CAHPS) report for
every medical plan and facility.
- What kind of accreditation has the plan received from groups such
as NCQA or the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) ( http://www.jcaho.org
)?
- How many patient complaints were filed against the plan last year
and how many were upheld by state regulatory agencies like the state
insurance commission or the state medical licensing board?
- How many members drop out of the plan each year? State insurance
departments keep track of “disenrollment rates.”
- Do the doctors, pharmacies and other services in the plans offer
convenient times and locations?
- Does the plan pay for preventive health care such as diet and
exercise advice, immunizations and health screenings?
- What do my friends and colleagues say about their experiences with
the plan?
- What does my doctor say about his or her experience with the plan?
