Choosing a Health Plan

If you have an ongoing condition such as diabetes, high blood pressure or heart disease, choosing a health plan that is right for you is particularly important. You will need the supplies and education necessary to keep your condition under control and access to the health professionals on your team.

But choosing a health plan is a big decision for everyone. Below are excerpts from the web site of the Agency for Health Care Research and Quality, the federal agency that works to improve the quality of health care that Americans receive.

Health plans vary widely. Research shows that Americans say that quality is the most important thing they think about when choosing a health plan. But research also shows that few people understand their options well enough to make an informed choice. 

Look for a plan that:

• Does a good job of helping people stay well and get better.
• Has the doctors and hospitals you want or need.
• Is accredited, if that is important to you.
• Provides the benefits you need.
• Provides services where and when you need them.
• Meets your budget
  

Find out:

• Does the plan have the doctors and hospitals I want or need?
• Does it do a good job of helping them get better when they are sick?
• Does the plan provide preventive services to help keep people well?
  

There are several different types of plans. The label doesn’t matter, but the characteristics of the plan do. It is important to understand your options and how they affect your choice of providers and services, costs and quality of care.

Some Questions to Think About

Are you happy with your current doctors?
Call their offices to find out which plans they are in. You may be able to choose a plan that will allow you to keep seeing those doctors without paying extra.

Does the plan include the kinds of doctors you will want to see?
Call the plans you are looking at to get a list of their doctors and other providers. Or, ask your employer's benefits manager. And remember, the hospital you go to often depends on the plan you are in and where your doctor has privileges. If going to a certain hospital is very important to you, keep that in mind when choosing a plan.

Do the doctors, pharmacies and other services in the plan have convenient times and locations?

Does the plan provide the benefits I need?
Which health care services are most important to you and your family? Do the plans you are comparing provide these services? Check the health plan materials from your employer or the plans. Or, ask your employer's benefits manager or the plan's customer service office.

Does the plan meet my budget?
Use the infomation provided by your employer or the health plans to fill in the table below so you can compare out-of-pocket costs.

Comparing out-of-pocket costs

Cost	Plan A	Plan B
How much will the premium cost me each month?
If there is a deductible, how much will I pay before the plan begins to pay?                    For prescription medicines?
How much is my co-payment each time I use a service? Doctor visit Hospital visit Prescription Dental
How much more will I pay if I go outside the health plan's network of doctors, hospitals and other services?

Look for a plan that:

•  Does a good job of helping people stay well and get better.
•  Is accredited, if that is important to you.
•  Has the doctors and hospitals you want or need.
•  Provides the benefits you need.
•  Provides services where and when you need them.
•  Meets your budget

Find out: 

• Does the plan provide preventive services to help keep people well?
  
• Does it do a good job of helping them get better when they are sick?
  
• Does the plan have the doctors and hospitals I want or need?
  

There are several different types of plans. The label doesn’t matter, but the characteristics of the plan do. So it is important to understand your options and how they affect your choice of providers and services, costs and quality of care.

 

Some Questions to Think About

Are you happy with your current doctors?

Call their offices to find out which plans they are in. You may be able to choose a plan that will allow you to keep seeing those doctors without paying extra.

 

Does the plan include the kinds of doctors you will want to see?

Call the plans you are looking at to get a list of their doctors and other providers. Or, ask your employer's benefits manager. And remember, the hospital you go to often depends on the plan you are in and where your doctor has privileges. If going to a certain hospital is very important to you, keep that in mind when choosing a plan.

Do the doctors, pharmacies and other services in the plan have convenient times and locations?

Does the plan provide the benefits I need?

Which health care services are most important to you and your family? Do the plans you are comparing provide these services? Check the health plan materials from your employer or the plans. Or, ask your employer's benefits manager or the plan's customer service office. For services that are provided by each plan, check the boxes next to those services that you want or need.

  Does the plan fit my budget?

  Use the health plan information provided by your employer or the plans to fill out the chart below so    you can compare out-of-pocket costs.