10 Key Considerations When Comparing Health Care Plans

Woman paying for prescription with health insurance
How to choose a good health insurance plan. zoranm/E+/Getty Images

Affordable health care is at the forefront of our minds these days. According to the National Patient Advocate Foundation (NPAF), shopping for your health insurance is very important in order to find affordable health care options and save money on a health insurance plan.

How to Choose Between Health Care Plan Options

Having to choose between multiple health care plans can be a daunting task. Besides understanding your various options, and what the terms mean in your health insurance policy, there are some key areas you should compare when choosing a health care plan.

Here are 10 key areas to consider when you need to find the best health care plan:

1. Your Doctor: Some health care plans require you to use their network of doctors. If you currently have a physician that you would like to keep seeing, then check first to see if your doctor is included in the health care plan you are considering. If you need to choose a new doctor from the health care plan consider researching the doctors credentials by calling the medical office they work, read online doctor reviews and check with the American Medical Association (AMA). Location and availability are other factors to consider when choosing a doctor. Find out the hours of the facility where the doctor works and see if the doctor is available all of those hours or only a few.

2. Specialists: If you have specific medical conditions or believe you may need to use specialists in the future, find out if you will be able to use a specialist and what the procedure is.

Check to see if you will always need to contact your primary care physician first and if you already have a specialist, if they will be accepted.

3. Pre-Existing Conditions or Waiting Periods: Sometimes in the confusion of choosing health care plans many forget to confirm how pre-existing conditions will be covered and whether there are waiting periods.

Make sure and review these details.

4. Emergency and Hospital Care: Find out what emergency rooms and hospitals are covered on your plan. In addition, find out what constitutes an “emergency.” Sometimes your definition of an emergency may not be the same as the health care plan you are considering and it could not be covered. Also, check to see if you need to contact your primary care physician before getting emergency care.

5. Regular Physicals and Health Screenings: If you like getting regular physicals and health screenings make sure they are covered. Most managed care plans cover these types of screenings yearly, but some independent insurance plans do not cover them at all. If you have children find out if well-baby check-ups and immunizations are covered.

6. Prescription Drug Coverage: If you currently use prescription drugs on a regular basis or think you may need to in the future check the details of prescription drug coverage. We've listed some good tips on prescription drug coverage including tips from the NPAF in our article on saving money on health care.This coverage type can vary enormously from plan to plan.  

7. OB-GYN: If you regularly see a Obstetrician or Gynecologist, find out if your doctor is covered in the plan you are considering.

If you are considering fertility treatments or will in the future, see what may be covered as some plans are now including varying types of fertility coverage. The same would apply for pregnancy coverage: find out how much you will have to pay out-of-pocket for pregnancy and birth care if you are pregnant or decide to plan to get pregnant in the future.

8. Additional Services: Consider what additional services are covered when comparing health plans. Some examples of additional services that may be important to you include: Drug and Alcohol Rehabilitation, Mental Health Care, Counseling, Home Health Care, Nursing Home Care, Hospice, Experimental Treatments, Alternative Treatments, Chiropractic Care.

Keep in mind that there are also policies like critical illness or long term care insurance that you may want to look at while you evaluate your health insurance options, these are considered supplemental health insurance.

9. Costs: Find out what deductibles you will need to pay before the health care policy will pay. Find out what percent the health care will pay after your deductible, as well what percent they will pay if you need to use a doctor, hospital, or specialist that is out of network. Find out if there will be Co-payments, these are the fees you need to pay when visiting your doctor, hospital, or emergency room. Finally, know your limits. Some plans have lifetime limits on how much the health care plan will pay and some have lifetime limits along with yearly limits.

10. Exclusions: The last consideration is the exclusions list. You will want to review each plan’s exclusions list to find out what is not covered and to see if any condition you currently have or expect to have in the future, is included on that list.