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Selecting a suitable plan

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Selecting a suitable plan

Selecting a suitable plan

Nobody can deny that the costs of health care have been increasing with each passing day. But everything’s not lost. You can still find the right option for yourself. This can make your health plans more affordable also. This section will provide you with details on how to select a plan that is just right for you. You will know about the choices you have and whether you can choose your own doctor. Get information on what to do if you want to visit a specialist not covered by your basic plan. Also get information on benefits covered and the costs involved.

  • Choices you have

    Basically, you have a choice between two basic designs:

    • Fee for service plans, or as they are called, indemnity plans. These plans usually offer you a wider choice of doctors and providers. These plans provide you a choice of including a health savings account or HSA together with your plan.
    • On the other hand, managed care plans enter into contracts with providers and doctors whereby they provide services to the patient at a reduced cost. These plans generally involve lesser paperwork and lower out of pocket costs.
  • Choosing your own doctor

    This is an important point for most Americans. You need to know whether the doctor you are currently visiting will accept health insurance of that particular company. If your choice of doctor is important to you, you would probably do better to find out what plans he accepts first.

  • Visiting a specialist not covered in your basic plan

    If consulting a particular specialist is important to you and the person is not covered in your basic plan, you might want to opt for a PPO, point of service (POS) plan or a plan with a high deductible. This will ensure that you get your choice of specialist. Of course, you have to be prepared to pay more for this facility.

  • Benefits covered

    Basic benefits are offered by most plans, but you need to consider the details also. Think about medicines, services and tests your family might need. Go into the details of plans. Find out about physician exams and screenings offered by the plans. Also find out about emergency care and hospitalization benefits offered by the plan. If you think specialist care is important, find out about the plan provisions regarding specialist visits also.

    You should also consider the pharmacy benefits offered by the plan if you or a member of your family takes prescription medication. Usually, you will find that the plans have preferred drugs on their websites and here you can come to know whether your drug is covered.

  • The costs involved

    No health insurance company will pay for all costs. That is why it is important for you to compare between plans to find the best one for yourself. The important thing to look out for is the premium per month and out of pocket costs you have to bear. Consider the questions below before you go for a plan.

    • Are there any annual deductibles? If yes, what portion of the costs will be covered by the carrier after you have paid those deductibles?
    • What co payments do you have to pay? Find out about co payments you might have to pay for services like doctor visits. Find out the differences you have to pay if you are availing of services outside the network.
    • Is there any exclusion in the plan? What about lifetime limits or annual limits?


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