Picking the right health insurance plan is confusing. What should you look for? And where do you begin? Paying for insurance is a gamble; if you are fortunate enough never to have had serious health issues, you may find yourself grumbling over "wasted money." However, if you have a serious health issue arise and need intensive medical treatment and hospitalization, you will wish you had insurance coverage. Sadly, there is no way to know about an unexpected illness, and sometimes when you realize you need the coverage, you find that your "pre-existing condition" cannot be covered. Choosing the right insurance plan can actually help save you money in the long run.
If you are lucky, you have a pretty decent health insurance plan through your employment. The homework -- most of it, at least -- has been done for you already, and you have some choice, albeit limited. Unfortunately, that is not the story for a growing number of Americans. Many do not have positions that include insurance. Often, the insurance that is provided cannot meet the needs of a growing family. There are also young graduates who no longer qualify on their parents' insurance plans but have not found jobs that include benefits. With the growing rate of unemployment, more Americans are losing their employer-provided benefits, as well.
Today the majority of Americans who are lucky enough to be insured are enrolled in managed care plans. Managed care was designed to keep medical costs and insurance payments lower; patients often require pre-certification and medical care within a network. Health maintenance organization, or HMO, plans generally allow for little decision-making on the part of the patient and medical provider and are often the least expensive plans. Traditional indemnity plans allow a patient and doctor the most freedom in treatment decision-making. In between are point of service, or POS, plans and preferred provider organization, or PPO, plans.
Whether you have a choice to make or are shopping for a plan for which you will self-pay, Kate Prout of the Aetna communications department offers the following suggestion:
"Review the 'four C's': changes to current plan options; cost of premiums, deductibles, copayments and coinsurance; coverage information, such as whether your doctor is still in the insurer's network; and choices of benefits. Find out what kinds of options are available."
To better understand the "four C's," your premiums are what you pay periodically for the insurance plan; the deductible is what you pay out of pocket before the insurance plan pays anything; copays are your portion of the bills; and coinsurance is the amount of coverage that you and your insurance company share responsibility for.
Prout suggests that you make a list of your benefit priorities based on what your health (and your family's health, if you are not single) has been like over the past year or so. If you have a chronic condition and require regular prescriptions, you might want to verify that both services for your ailment and a pharmacy plan are included. Verify that the doctor who has been treating you and any necessary specialists are included in the network of providers.
Most employer-insured participants who lose coverage are entitled to pay for a temporary insurance under COBRA; the plan mirrors the previous insurance, however the employer no longer pays into it, so the cost may seem exorbitant but is still generally less than a self-paid individual plan. Many states offer reasonably priced (for the market) options to insure children, self-employed people and small businesses in special situations. In New York, there is a program called "Healthy NY," which provides essential health needs and emergency services. Low-income families without benefits can register their children in Child Health Plus.
If you are considering changing health plans, be sure to do a side-by-side comparison of benefits. Also, note additional benefits, such as dental and vision. Assess what your previous insurance usage has been to make sure that any differences would meet your needs. Allow for anticipated lifestyle changes, such as marriage and children. Be aware that generally, the higher your deductible the lower your premium and vice versa.