Choosing a Plan That is Right For You and Your Family

The abundance of available medical or health care insurance plans on the market can make choosing a policy and a provider an intimidating proposition. Consider the following factors when searching for a health care plan that is appropriate for the needs of your family.

Working with a physician: many health care insurance providers have a pool of doctors and health care professionals with whom they are affiliated. You may be forced to find a new family doctor if yours is not a member of this network. If you don’t mind switching doctors, take care in choosing a new physician. Ideally, see if a doctor in your area who has verifiable credentials and accessible office or clinic hours services your insurance plan. The American Medical Association can help you determine a doctor’s legitimacy and in which hospitals and medical facilities he or she has working privileges.

Access to specialists: some plans limit coverage of fees associated with consultations with medical specialists. Read the fine print to see if your plan will pay for access to specialists. This is especially important if you have, or anticipate having, a particular condition that requires a specialist’s care. Similarly to your family doctor, you may have to switch specialists if yours is not part of the insurer’s established network. Though common, OB-GYN care may be considered specialist care, so ask specifically whether this service is available under your plan. Fertility and pregnancy treatment are also areas that should be addressed directly.

Pre-existing conditions: verify that any pre-existing conditions you have will be covered under a new plan before you sign. You may experience a degree of flexibility on this point if you are applying for employer-sponsored insurance, but you will likely find greater resistance if you are applying for private individual health insurance.

Emergency care: your insurance provider may insist that you go to only certain hospitals for emergency treatment, or that you contact your family doctor before obtaining emergency care. Have your provider define emergency so you aren’t left with unpaid claims for emergency room visits for conditions that don’t qualify for coverage.

Check ups and screening: there is great variance between insurance plans when it comes to check ups and screening. Determine if, and how often, you can expect to be able to submit claims for physicals and other preventative measures.

Medication: is it covered under your proposed health insurance plan? Prescription drugs, particularly if required on an ongoing basis, are expensive. Having prescription drug costs covered as one of your health benefits can add up to substantial savings over the years. If prescription medication is a benefit of your plan, ask whether both brand and generic varieties are covered.

Extras: additional services such as drug and alcohol rehabilitation, counseling, home care, chiropractic, massage therapy, alternative treatments and palliative or hospital care should be outlined in your service agreement. With perhaps the exception of massage therapy, no one likes to think about having to use services such as these, but it is a good idea to have them included in your health care policy if you are able to do so.

Fees: a health care insurance plan will help you manage the costs of health care, but nearly all plans incorporate a fee structure on top of the monthly premiums you pay. Fees may come in the form of deductibles, percentages of services that aren’t fully covered, or penalties if you do not comply with your agreement (i.e. you seek care from a doctor that is not affiliated with your insurer’s network). You may also have to pay for care once you surpass a monthly, annual, or lifetime limit on specific services. Find out what these limitations are before you finalize the purchase of your health care insurance.

Exclusions: you will reduce the potential for rejected claims if you have a clear idea of what your plan covers and what it does not. There will always be grey areas, but for the most part, you should know which claims are acceptable and which will meet resistance.

Regardless of the plan you choose, the best health care plan is still a preventative approach based on sound, moderate living.