How to select a health plan

Learn how to select the right health care plan.

Tutorial

Traditional health insurance and Medicare are fee-for-service systems. That is, every time a covered service is used, the patient must pay a percentage of the cost. These costs can vary widely among health plans and it is best to comparison shop between providers within the health plan offered by your employer (or Medicare) and/or your spouse's health care plan.

Don't choose a health care plan solely based upon its monthly premium. There are other costs to consider, such as non-allowable expenses for pre-existing expenses. Convenience can also cost. Plans that do not place any limits on what doctor you can see and when are often more expensive. Other plans may have provider networks you must use. Through these networks, health care plans require referrals and limit your choice of primary physician and hospital provider.

Other tips on how to choose a health plan include:
● Check each plan's provider list to make sure all your providers are included.
● Make sure you understand what the plan will cover and what your out-of-pocket expenses will be for home health care, doctors' visits, hospital stays, prescriptions, and durable medical equipment.
● Make sure the health plan you are considering has a stake in staying in the community or with the company you work for. Choose one that has a local track record and a large number of enrollees to reduce chances they will revoke your coverage because it is not cost-effective for them to operate where you live.
● Review the rules, if any, for changing primary care physicians.
● Make sure you understand when a referral for a specialist will be necessary.
● Make sure the plan's appeal process makes sense to you and will protect you adequately.