Choosing a Health Plan
Most people spend more time selecting their clothing
than they do choosing a health plan. Does
this make sense?
Choosing a health plan
is more than comparing prices. It’s matching
the needs of you and your family to the benefits
of the plan and the philosophy of the company.
And because most people have one chance a year
to make the right decision, it’s worth
a little time to make the choice that’s
right for you.
What do you and your family need?
Young families:
review prenatal care, delivery room charges,
well-child and sick child copays, allergy shots.
College age
kids: look for out of area coverage
for urgent care and follow up care after an
injury (physical therapy after a sports injury),
compare any college medical plan with the plan
you are considering.
Healthy adults:
are there benefits you can use when you’re
not sick, such as coverage for eye exams and
birth control, programs to help you stay healthy
or
health club discounts/memberships.
Adults who travel
for work: if you are assigned out of
the area for several months, are your routine
necessary lab tests and office visits covered?
Does the plan have a national network of doctors,
hospitals and pharmacies?
Adults with
ongoing medical concerns: does the
plan cover the benefits you regularly need?
Are there programs and information to help you
better manage your medical condition and improve
or maintain your health?
Urgent and emergency
coverage: are you covered nationwide
or worldwide? Is the copayment for an urgent
care center the same as the copay for an emergency
room visit?
How
do you budget your money?
If you are on a tight
budget and account for every dollar, you may
prefer a plan with low copayments and a larger
amount taken from your paycheck. In this approach
your health expenses are more predictable each
month.
If you prefer more money
in your paycheck you may prefer a plan with
higher copayments and less money taken out of
your check. In this approach you may want to
set some money aside for “unpredictable”
health care expenses such as copayments,
How
do you compare prices?
The plan with the lowest
premium is not necessarily the least expensive
plan. Some basic math and about 15 minutes could
save you money and make sure you receive the
level of benefits you need.
Compare health plans
Use this chart to look at plan options that are most likely to meet your needs. Think of and list your likely expenses for the year and your cost for coverage. Here are a few examples to get you started:
Money taken
out of your paycheck
|
# of pay
checks per year
|
Total spent
for health plan premiums |
$25
|
52
|
$1,300 |
Copay per
visit to doctor’s office
|
# visits
per year
|
Out of
pocket copays |
$15
|
7
|
$105 |
Copay per
visit to emergency room
|
# visits
per year
|
Out of
pocket copays |
$50
|
1
|
$50 |
Copay per
routine eye exam
|
# visits
per year
|
Out of
pocket copays |
$15
|
4
|
$60 |
Vision
wear discount
|
Cost for
one pair eyeglasses
|
Total spent
for eyeglasses |
| 20% |
$250 |
$200 |
| TOTAL: |
$1,715 |
What
type and level of service do you expect?
- Does the plan offer
member service hours that fit your work and
leisure schedule (early morning or later in
the evening)?
- Will the plan answer
a phone call quickly? What is their average
speed of answer?
- When you call the
plan for information, are you greeted warmly
and professionally, or are you rushed through
the call?
- If you request information
is it sent promptly?
- Do you speak with
a person or a phone tree?
- Is there on-line
access to your claims history and account
information?
- Is the Web site
easy to use and can you find the answers to
your questions?
- Is help available
in finding a doctor if you are new to the
area?
Extra
programs, values and benefits
- Does the plan offer
programs to help you stay healthy or is its
focus on claims payment only?
- Are there benefits
that you can use even when you are healthy,
such as stress and time management, health-related
outings, lectures and workshops?
What
do other people say about the plan or the company?
- How is it rated
by the National Committee on Quality Assurance?
(www.ncqa.org)
- What is its rating
in the HMO Report Card (www.nyshaf.org)?
- How favorably is
it rated by the New York Sate Guide to HMOs
(www.ins.state.ny.us)?
- What are the member
satisfaction ratings?
- What do your friends
and coworkers think about the company or the
plan?
- Does your doctor
find it easy to work with the plan?
|
Need
help choosing a health plan?
