Tips For Choosing Health Insurance
Below are some practical tips for selecting a health insurance policy that include advice from experts and suggested research. The Affordable Care Act (ACA) and its implementation over the coming years will likely have some effects on health insurance providers, the products and services they offer, and the health care community overall. Ask questions and consider all options before making an informed decision.
Ask your doctor
Before getting into the details about how to select a health insurance policy, consider asking your doctor. Doctors are used to dealing with insurance providers and may have some insightful advice. From a physician's perspective, they like consistency in administration, because inconsistency costs them extra time and money, and it can lead to mistakes in billing, and even treatment choices. They no doubt have preferred insurance carriers and can advise you on which are popular or garner the least complaints.
Also, if you have a preferred doctor, it is wise to ask what insurance plans he or she accepts to ensure that you can continue visits when you select a new insurance provider. Though your doctor's advice shouldn't be the end all be all––you must still research which policy will be the most practical for you and your family––it can serve as a jumping off point.
Different options in different states
The state you live in will no doubt shape the options you have. The health care system in the United States is dispersed and distributed among the various states, and must be considered as being state-based. Not all health insurance plans are offered in all places.
The ACA establishes health care insurance exchanges where people can compare and purchase policies. These organized marketplaces can be accessed through HealthCare.gov. The idea behind the exchanges is to create competition between insurance plans to reduce costs while making information about different offerings easily accessible for consumers. Within these exchanges, some are state-run, some are federally run, and some are a combination of the two. Find out what kind of exchange individual states are offering through HealthCare.gov.
Researching health care coverage
People have different approaches to the process of selecting health care insurance. They are limited by the amount of time they have to devote to the evaluation and decision process. Consider researching health coverage options through government websites like HealthCare.gov and USA.gov. Also consider reviewing information through third party independent researchers like Consumer Reports.
HealthCare.gov
If obtaining your health care insurance from the marketplace, you will find four classes of plans available to you, although each one contains the same baseline essentials. For example, the bronze plan covers 60 percent of all health care costs, while those insured on the platinum plan would be responsible for 10 percent of out-of-pocket expenses. [1]
You must select a plan that addresses your needs and one that you can afford. Your monthly premium costs determine the portion of the bill you pay for things like hospital visits and prescription drugs. Basically, it determines your out-of-pocket expenses. HealthCare.gov has streamlined the process of identifying your individual needs with a new tool that asks questions about your situation to find the best plan for you.
The marketplace allows for shopping and comparing plans online. Essentially, the marketplace may be a good option for part time workers without job-based coverage, unemployed Americans, and those looking to procure lower coverage costs based on their incomes. [2]
Consumer Reports
If you want to improve your approach and enhance your knowledge and tools for evaluation, consider Consumer Reports. It offers independent expert advice and original research through surveys, so it is a strong source for general information. Very specific comparison information among various products may require a subscription fee. However, knowing the right questions to ask, directly to insurance providers, may be a helpful starting point for conversations with them.
Consumer Reports suggests that you get a plan that covers as much as possible so you don't come up short in an emergency. In other words, be prepared for the unexpected. It also suggests that you limit your out-of-pocket expenses.
Consumer Reports outlines three plans: PPOs, HMOs, and Point-of-Service.
"Most people in the U.S. are enrolled in some form of 'managed care' health insurance—either a preferred provider organization [PPO] (34 percent), health maintenance organization [HMO] (31 percent), or a point-of-service (9 percent) plan, which is a hybrid of the other two.
Both PPOs and HMOs contract with doctors, hospitals, and other healthcare providers to create a network of participating providers. But there are important differences, too, and understanding them is key to choosing a plan that's right for you." [3]
Consumer Reports also put out a "watch for junk plans" alert, which are described as low-premium plans that are "skimpy" and will duck and dodge covering basic medical expenses. The ACA and HealthCare.gov will probably weed those plans out because they won't meet the standards set by the law.
Finally, Consumer Reports has an online tool for evaluating specific offerings in your state. You have to subscribe to see all the results, but it is a low cost to have access to such comprehensive information. The tool offers health-insurance plan rankings with the help of data from the National Committee for Qualified Assurance.
USA.gov
USA.gov is the U.S. government's official website for providing "trusted, timely, valuable" government information to the American public. It is administered by the Federal Citizen Information Center.
Particularly useful advice is to ask yourself the following questions, as posed by USA.gov.
- Do I have the right to go to any doctor, hospital, clinic or pharmacy I choose?
- Are specialists such as eye doctors and dentists covered?
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care and physical therapy?
- Does the plan cover home care or nursing home care?
- Will the plan cover all medications my physician might prescribe?
- What are the deductibles? Are there any co-payments?
- What is the most I will have to pay out of my own pocket to cover expenses?
- If there is a dispute about a bill or service, how is it handled? In some plans, you may be required to have a third-party decide how to settle the problem.
There's a lot to consider when choosing the perfect health insurance plan, but with some research and advice from experts, you will be able to find the most practical option for you and your family.
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Sources:
[1] http://101.communitycatalyst.org/aca_provisions/coverage_tiers
[2] https://www.healthcare.gov/health-insurance-marketplace
[3] http://www.consumerreports.org/cro/2012/09/understanding-health-insurance/index.htm
This article was written by James George via Examiner.com. James George began his career as an instructional media consultant and managed a broadcast quality tv studio for AT&T. He later became VP and Publisher for Hitchock Publishing Division of The American Broadcasting Companies. He was PR Director for Ensslin & Hall Advertising and managed the Media General Broadcast and Eden's Broadcasting accounts as well as GTE. He founded Talon Publishing Inc which he sold to Daniel S. Appleton. Now, he writes thousands of articles on art, film, and politics.
