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Health insurance
Health insurance can be the largest expense that a family can face today.
In many states, the cost of a family health insurance plan can exceed the rental
of a three bedroom apartment. Today's health insurance system is complex and ever
changing. Educating yourself prior to making a buying decision should help you
with your insurance buying decision.
What kinds of health insurance are there?
There are essentially two kinds of heath insurance -- Fee-for-Service and Managed
Care. Although these plans differ, they both cover an array of medical, surgical
and hospital expenses. Most cover prescription drugs and some also offer dental
coverage.
Fee-for-Service.
These plans generally assume that the medical professional will be paid a fee
for each service provided to the patient. Patients are seen by a doctor of their
choice and the claim is filed by either the medical provider or the patient.
Managed Care.
More than half of all Americans have some kind of managed-care plan. Various plans
work differently and can include: health maintenance organizations (HM0s), preferred
provider organizations (PPOs) and point-of-service (POS) plans. These plans provide
comprehensive health services to their members and offer financial incentives
to patients who use the providers in the plan.
How do I pick a health plan?
If your employer gives you a choice of plans or you need to purchase your own
coverage, it is crucial that you understand your health insurance choices and
pick the insurance that is best for you and your family.
Here are some questions you should consider when choosing a health insurance
plan:
How affordable is the care?
What is the monthly premium?
Should I try to insure most of my medical expenses or just the large ones?
What out-of-pocket expenses (deductible) will I have to pay before my insurance
plan starts to reimburse me?
After I’ve met my deductible, what percentage of my medical expenses are
covered?
How much am I reimbursed if I use physicians outside of the insurance company’s
network?
Does the plan cover the services I am most likely to use?
Are the doctors, hospitals, labs and other medical providers that I use in the
insurance company’s network?
If I want to use a doctor outside the network, will the plan permit it?
How easily can I change my primary-care physician?
Do I need to get permission, or a referral, before I see a medical specialist?
What are the procedures for getting care and being reimbursed in an emergency
situation, both at home or out of town?
If I have a preexisting medical condition, will the plan cover it?
If I have a chronic condition such as asthma, cancer, AIDS or alcoholism, how
will the plan treat it?
Are the prescription medicines that I use covered by the plan?
Does the plan reimburse alternative medical therapies such as acupuncture or chiropractic
treatment?
Does the plan cover the costs of delivering a baby?
What is the quality of the insurance plan I am looking at?
How have independent government and non-government organizations rated the plan?
For example, the National Committee for Quality Assurance ( http://www.ncqa.org
) issues a Consumer Assessment of Health Plans (CAHPS) report for every medical
plan and facility.
What kind of accreditation has the plan received from groups such as NCQA or the
Joint Commission on Accreditation of Healthcare Organizations (JCAHO) ( http://www.jcaho.org
)?
How many patient complaints were filed against the plan last year and how many
were upheld by state regulatory agencies like the state insurance commission or
the state medical licensing board?
How many members drop out of the plan each year? State insurance departments keep
track of “disenrollment rates.”
Do the doctors, pharmacies and other services in the plans offer convenient times
and locations?
Does the plan pay for preventive health care such as diet and exercise advice,
immunizations and health screenings?
What do my friends and colleagues say about their experiences with the plan?
What does my doctor say about his or her experience with the plan?
If I change jobs or become unemployed, can I bring my coverage with me?
Where can I get more information regarding health insurance?
Information on the various health insurance plans that are available today
is available from the three leading health insurance trade associations.
American Association of Health Plans
http://www.aahp.org
Life and Health Foundation for Education
http://www.life-line.org
Health Insurance Association of America
http://www.hiaa.org
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