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Tips on Choosing the Right Health Insurance Plan

Wednesday, October 6, 2010

Author: 
Erica Cross
Wednesday, October 6, 2010

Photo: Courtesy of Francesco Marino

With the cost of health care on the rise, many Americans struggle with finding the right health insurance plan that will give them the coverage they need without breaking the bank. Getting the type of health insurance that is right for you is important so that you can be covered whenever you need it. Before choosing a health care plan, some things that you want to compare are:

  1. Premiums (how much the policyholder needs to pay for coverage)
  2. Coverage/benefits (look at your history and what you use the most; consider dental insurance, eye care exams, prescription coverage, etc.)
  3. Access to doctors, hospitals and other providers (check if limited to a primary care physician or if you can choose any doctor you want)
  4. Access to after hours and emergency care (may be limited depending on the provider)
  5. Out-of-pocket expenses (co-insurance, co-pays and deductibles)
  6. Exclusions and limitations (long-care illness, lifetime policy limits, etc.)

Two major categories of insurance plans are Indemnity Insurance and Managed Care. Indemnity insurance offers more flexibility in choosing doctors and hospitals, so you can choose any doctor that you want. However, you generally need to pay the money up front and then file a claim with the insurance plan. In other indemnity plans, the plan only pays for part of the medical bills, and you pay for the rest. You need to spend a certain amount of money per year before your insurance plan begins to pay benefits (this amount is called your deductible) and deductibles range from $100-$300 (for an individual) or $500+ (for a family). Also, indemnity insurance often has a lifetime limit. Experts recommend that you select a policy with a lifetime limit of at least $1 million.

Managed care costs decrease when patients use doctors who participate in the plan (these doctors are called network providers). One of the benefits is that you don’t need to fill out any insurance forms or submit any claims to the insurance company. You generally pay a co-pay of $10-$20 for an office appointment and the insurance pays for the rest. The insurance company generally has a list of medications that the plan covers (called a formulary), and the co-pay depends on whether the person is buying a medication that is part of the formulary. For example, the patient only need to pay $20 for a medication that is listed on the formulary, while they may need to pay $40 for a brand name drug not listed on the formulary.

There are many factors to consider when selecting your type of health care insurance. As a college student, it might not seem like something that you need to worry about right away, but it is worthwhile to take some time to fully examine all of your options. You don’t want to wait until you have an emergency to find out what your health care plan does or doesn’t cover. The Agency for Healthcare Research and Quality has great resources for learning more about the different types of heath care plans.

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