With open enrollment season in full swing, now is the time to compare insurance policies to make sure you have the right one for your life situation.
“Health insurance should serve two purposes,” advises Dr. Cheryl Bettigole, president-elect of the National Physicians Alliance. “It should be a way of insuring people and financial protection in terms of health care. It’s important your plan serves both purposes.”
Analyzing insurance plans can be eye glazing, but it is important to pick a plan with coverage that covers your health-care needs. Here’s what you need to know when choosing an insurance provider.
Do Your Homework
Analyzing different health-care plans can seem like you are swimming in an endless bowl of alphabet soup between HMOs (health-maintenance organizations), FFS (traditional fee-for-service plans) and POS (point-of-service plans), but take the time to learn the differences--they differ in restrictions and rules that could cause big problems down the road if you aren’t aware of policies.
When doing research, narrow in on your priorities, especially for those in need of a particular coverage.
According to Diane Archer, special counsel and co-Director of the Health Care for All Project at the Institute for America’s Future, HMOs are the most restrictive on coverage.
“The biggest thing to remember when picking your health insurance plan is you are choosing to protect yourself against unforeseen problems when buying coverage,” she says. “The best idea is to research plans and choose something that protects you against potential complications.”
Know What You Can Afford
While it shouldn’t be the sole factor when it comes to choosing coverage, it is important to know how much you can afford to pay in weekly contributions, premiums, co-payments and deductibles.
According to Bettigole, many people simply cannot afford plans they choose and find themselves getting stuck without medications and little care.
Archer warns if you go for the plan with a deductible you must be able to pay it off.
According to Bettigole, many senior citizens are buying into “attractive plans,” and not considering all of the costs which leads to financial hardships down the road.
Identify What’s Covered
Archer recommends finding out which doctors and hospitals accept a potential insurer, and make sure they are bountiful where you live.
It is also important to make sure potential doctors are accepting new patients. In several cases, doctors have already maxed out on their patient load and are no longer accepting new clients.
Know Who Charges What
Be sure to check out doctors’ charges, specialty fees, prescription charges and co-payments--this will give you a good idea of how much the plan costs.
Jeff Lawler, president of the Employee Benefits Division at DS&P Insurance Services, advises individuals find out what is excluded in certain plans.
“Look at the contingencies,” he recommends, “some companies have a ‘subject to underwrite’ clause, and the initial quoted price may not be the final cost of coverage. Be aware of your situation.”
And don’t forget about travel care, if you are always on the go, treatment is often not covered out of network and can cost you a pretty penny.
“Don’t be mislead by percentages on plans,” Archer says. “Most of the time, companies will neglect to advertise what the out-of-pocket charges are for out-of-network care, or travel care.”
What is the health insurance ranking?
When you have narrowed your choices down, look up the ranking of each plan
“A great resource to use when researching certain insurance companies and plans is asking the doctors directly,” Lawler suggests. “You can hear reliable information from a doctor’s offices employees and clients regarding each company.”
Seek Professional Help
If you still aren’t comfortable making a decision after reviewing different plans, seek professional help.
“There are a number of people who are experienced in the area and work to help with the process,” recommends Lawler. “When you are looking for a broker, ask how long they have been working? What their background is in the field? Asking questions will ensure you are working a skilled professional.”



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