Shopping for Health Insurance

Health insurance is purchased to provide you and your loved ones with basic health care services. Everyone needs to have a good health insurance plan, and the days are gone when you could choose a doctor and your insurance could be counted on to cover the bill. Today, you may need to obtain permission from insurance companies before treatment and often limited in your choice of doctors you can choose for your care. Health insurance is very expensive and you should shop carefully to find the best protection for your family.

Types of Health Insurance Plans

When selecting an insurance plan, carefully consider the monthly costs out-of-pocket expenses such as co-payments, deductibles, and benefits that are covered. Health insurance plans cover services in many different ways.

• HMOs (Health Maintenance Organizations) are prepaid health plans in which patients receive care from a specified group of doctors, clinics, or hospitals. The HMO receives a fixed fee for your covered medical care, and they provide basic preventive care as well as treatment for health problems before they become serious illnesses.
• PPOs (Preferred Provider Organizations) allow you to see any doctor anytime, but seeing a "preferred provider" who is part of the plan's network is often considerably cheaper.
• Fee-for-service insurance offers the most choices of doctors and hospitals. You can choose any doctor and go to any hospital in any part of the country. However, the insurer only pays for part of your doctor and hospital bills. Some services are limited or not covered at all and you should ask about preventive health care coverage such as immunizations and well-child care. There are two kinds of fee-for-service coverage: basic and major medical. Basic health insurance covers charges for hospital, surgical, and medical expenses. Major medical insurance takes over where your basic coverage leaves off. It covers the high-costs of treating serious illnesses or injuries that may require treatment over a long period of time.

When selecting an insurance plan choose one with high maximum benefits and comprehensive coverage, and purchase only as much insurance as is needed. If possible, purchase a group policy (one offered by companies to all their employees or to another type of specified group) because they generally offer better coverage for less money. Compare health insurance policies as they vary greatly in terms of services they offer and costs.

Questions to Consider

Here are some helpful questions to consider as you shop for health insurance:

• How much is the co-payment?
• How much is the yearly deductible?
• How much is the co-insurance?
• How much is the monthly premium?
• Are my doctors in your plan?
• Does this insurance have a pre-existing clause?
• What is the maximum amount the insurance will cover for different services?
• Will my insurance charge more if I use a doctor or hospital outside of the plan? If so, how much?
• Are there limits on the choice of physicians, clinics, hospitals, and labs?
• Are referral and pre-authorizations needed?
• Are routine services covered such as physicals, preventive care, well visits, and immunizations?
• Does this replace Medicare?
• Are programs that focus on helping members with specific, chronic conditions such as asthma, diabetes, or heart conditions covered?
• What inpatient services are covered?
• What outpatient services are covered?
• Are Behavioral Health services covered by this plan?
• Does the policy cover pharmacy services?
• How much is the pharmacy deductible?
• How much is the pharmacy co-payment?
• How much is the pharmacy co-insurance?
• Can I use my regular pharmacy or are mail order pharmacies available?
• Is there a yearly limit on prescription drug coverage?
• Will I have to pay more if I prefer to use brand name instead of generic drugs?
• Do you cover the drugs I use?
• Are eye exams, glasses, contacts covered?
• Are dental exams/treatments covered?

Choose a Plan that is Best for You and Your Family

There are many different types of health insurance plans with pros and cons. There is no one "best" plan. The plan that's right for a single person may not be best for a family with small children and a plan that works for one family may not be right for another. It is up to you to watch out for your family's health and well being.