It is always a challenge to decide on the right health plan to go for given that there are so many companies offering the service. It concerns your life and it is your money; therefore, it makes a lot of sense to look at different aspects and make a right decision.
But whether you are selecting an individual plan, or one for your family, or even for your employees, it can all make a huge difference if one knows what to look for.
To the aim of assisting you in going through this process, I have designed a few steps to guide you in the selection of the most suitable health plan that suits your desires, style and pocket. This way it is easier to make a decision and choose the plan more suitable for you.
7 steps to choose the best health plan
Here are the following guidelines to assist to come up with the right decision of selecting the best health plan that addresses your needs and give you satisfaction.
1. Assess Your Healthcare Needs
The first thing, one needs to consider, is what kind of health care they require to meet their needs. Consider how often you see a doctor, what type of service you might require and if one has any chronic diseases. Are you a patient who requires frequent visits in the specialists’ offices, or do you require insurance for the emergencies only?
In the case that you have a family, do consider all the family members, within expected treatments or medications. Knowing these needs will assist you in ranking the most important requirements you want in a health plan whether it is cheap premium, low deductible or wide range of service coverage.
2. Learn the Differences between the Various Plans
HMOs, PPOs, EPOs and HDHPs are some of the common health Plan types that has it’s own benefit & vice versa. An HMO (Health Maintenance Organization) plan has rather affordable premiums in exchange for which you are assigned a primary care provider and need a referral to a specialist.
PPO or the preferred provider organizations provide the patients with a higher level of freedom in selecting the healthcare providers of their choice but they are usually costly in the sense that the premium charges are usually high plus the out of pocket expenses.
There is a type called EPO or Exclusive Provider Organization which is an intermediary between HMOS and PPOs in terms of flexibility. HDHPs coupled with HSAs submitted even lower premiums but with greater deductibles than Traditional plans and Consumer Directed plans. This knowledge should assist you in selecting a plan that you are willing to pay for and the amount of freedom when choosing your doctors you desire.
3. Going beyond the Premium cost Comparison
Although the rate of monthly premium is an important consideration, it’s not the only one that a consumer needs to think before buying a particular health plan. I pay attention to other top of the pocket expenses such as the deductible, the copayment, coinsurance, and out-of-pocket limits.
These cost make up fast not only to the individual patronizing the health center, or to a member of the family in need of more frequent medical attention. For instance, a low premium plan may come with a high deductible; this is, you will have to cater for a considerable amount before the insurance takes the burden.
Still, with a higher premium will also come access to more services rendered at much cheaper and reasonable copay and deductible charges. Remember that all these costs have to be put into consideration with the healthcare requirements and the amount of money you have.
4. Check the Provider Network
The next important step is to verify whether your preferred primary care physicians, hospitals or specialists are within the health plan’s network.
Almost all insurance plans have tiers of healthcare service providers, and using providers in the tier that is deemed as ‘in-network’ often comes cheaper. If you have a specific doctor or specialist that you would like to be taken care of by then he or she should also be included in the plan’s network.
HTQ2 Pulling out of network may result to higher amounts charges or even full out of pocket cost. Healthcare providers must be in-network so you can opt to use them as this will be cheaper and will mean that your health records will be kept intact.
5. Assess the Plan in Terms of Provided Advantages and Opportunities
Every health plan is different and they are not all going to have all of the necessities that you’ll need. Make sure that all the options, you are likely to require in the near future, are included in the plan; for instance, prescription medications, inpatient and outpatient mental health care, childbirth, and treatments like chiropractic or acupuncture.
Check for other perks there may be, which are also valuable to you, as for example, health promotion services, video and remote consultations and benefits, such as, for instance, a discount for gym membership. Information on all those additional features provided by the health plan will give you good foundation that you can use to choose the right business.
6. During the summer the member should review the Plan’s Drug Formulary
This means that if you or anyone on your plan takes regular medications you may want to check the insurance drug formulary which is a list of medications that the insurance covers. It is important to know that not all of the plans include the same drugs and some of them could have a higher deductible or make you try a cheaper brand first.
It means that if people take medications frequently their worries about the coverage, prices and the amount of money they need to spend is reasonable. If you use specialty medications then the best thing to do is check if you need prior authorization or if it has any limitations.
7. Consider the Plan’s Customer Service and Support
Last but not the least, do not under estimate the factor of customer service/ customer support. You need a health plan provider who can be reached easily, addresses you promptly and effectively when you have questions or concerns.
You should read what others are speaking about the insurance company’s customer service seeking for both – reviews and ratings.
It may provide you with an idea on the degree of simplicity that underlies problem solving, filing claims, or even searching for information when necessary. It is not only the figures; it is also an indicator of how well a company treats its members in regard to their health.
