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Shopping for Health Insurance
Health insurance is purchased to provide you and your loved ones with basic health care services and to ensure access to care in case of serious illness or accident. 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 must choose doctors from a short list of unfamiliar names. Health insurance is very expensive and you should shop carefully to find the best protection for your family.
When selecting an insurance plan, carefully consider the monthly costs (premiums), out-of-pocket expenses including copayments and deductibles, and what benefits are covered. Health insurance plans differ widely in the variety of services they cover and the way they cover them.
- 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. Here are some questions to help compare insurance plans:
- Is the policy a group or individual plan?
- Is the insurance comprehensive, including hospital, surgical, and medical benefits? Does it include major medical insurance?
- Do you need an individual or a family plan? Are maternity and new-baby benefits included?
- Does the policy cover preventive care, such as well-child visits, immunizations, and yearly physicals?
- What inpatient services are covered? (Services received after being admitted to the hospital as an inpatient such as lab, x-rays, or drugs.)
- What outpatient services are included? (Services received as an outpatient in an emergency room, clinic, or same day surgery center. )
- Are there limits on the choice of physicians, clinics, and hospitals? Do you need referrals to see a specialist or to get a second opinion?
- Are mental/emotional care services covered? Is counseling or rehabilitation offered for mental or emotional conditions, or drug or alcohol addiction?
- Does the policy cover pharmacy/drugs?
- What are the out-of-pocket expenses? Is there a yearly deductible? Are there copayments for services? What are the maximum coverage or benefits provided?
- Is the company licensed in your state? Is the company or agent a reliable and reputable one? Are claims paid promptly and without hassles?
It is important to compare health insurance policies. Obtain sample policies from several different companies to compare benefits. When selecting health insurance, it is best to obtain a copy of the policy and read it carefully. If the language appears conflicting or difficult to understand, do not hesitate to ask the company representative for an explanation. Be sure the coverage is a fit for you so shop around. Policies vary greatly in terms of services they offer and costs.
The many different types of health insurance each have 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.
Donna Stauber, PhD, CHESPresident, Rebuats, Inc.
RESOURCES
Health Insurance Association of America, 1201 F Street, NW Suite 500, Washington, D.C. 20004-1204; 202-824-1600; www.hiaa.org
INTERNET RESOURCES
www.ahcpr.gov/consumer/insuranc.htm
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