10 Considerations When Comparing Health Care Plans

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Finding affordable health care can be tricky when we look at all the available options. It is often hard to figure out what the differences are in coverage which makes it hard to shop around. According to the National Patient Advocate Foundation (NPAF), shopping for your health insurance is a very important step in finding affordable health care and to save money on a health insurance plan.

How to Choose Between Health Care Plan Options

If you need to figure out how to choose between different health insurance options, besides understanding what the terms mean in your health insurance policy, here are some key areas you should compare when choosing your health care plan.

10 Key Factors to Consider to Help You 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 who you would like to keep seeing, check 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 a doctor's credentials by reading online doctor reviews, and checking 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. Some health care plans require a referral before you can see a specialist and other types of health insurance do not. If you already have a specialist, see if they will be accepted.

3. Waiting Periods: Sometimes in the confusion of choosing health care plans, you may forget to confirm how pre-existing conditions will be covered and whether there are waiting periods that will impact your current care. Make sure to review these details.

4. Emergency and Hospital Care: Find out what emergency rooms and hospitals are covered on your plan. In addition, find out how the policy defines an “emergency.” Sometimes your definition of an emergency may not be the same as the health care plan you are considering. 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, find out what will be covered as part of a wellness plan or what is included in preventative care, and if there are any limitations. 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 here..This coverage type can vary a lot 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.

If you have access to a Health Savings Account (HSA) or FSA, be sure and look into the benefits of a high deductible health insurance plan. Learn more about the benefits of HSA and FSA here.

9. Costs: Find out what deductibles you will need to pay before the health care policy will pay. Learn 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 so you don't have any surprises once you have selected your health insurance options.