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How should we choose our health plan?

Before you get bogged down in figuring out your options, consider for a minute that if you’ve got choices for health insurance, you’re pretty darn lucky. How do you know if you do? You may have several alternatives if you and your spouse are working at full-time jobs and your employers offer choices for coverage. When you’re weighing out options, here are the key things to consider:

Cost
When you get your benefits package from your company, each plan will provide a prospectus listing the rate schedule for each option. Your companies may have very different contribution requirements -- some companies pay 90 percent of the premium, some pay 50 percent, and others pay every variation in between. If you're planning on having a baby, make sure you look ahead and see how much family coverage will cost you.

You’ll be able to see what the copays are for office visits, prescription drugs, and hospital visits, and whether you’ll need a referral to see a specialist. If you're a frequent gym-goer, look for a plan that offers reimbursement. If you're planning on having a child soon, pay careful attention to the benefits for pregnancy and well-child visits -- many plans require no copay for those services. Also, be sure to check out the mental health benefits, which can vary greatly.

Services
Look at the breakdown of services for each plan. This is when you’ll notice the real differences between Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Service Plans (POS). Each has a different way of approaching copays, referrals, and deductibles. HMOs typically require you to only see doctors within a network while PPOs are more flexible about going outside of a network; POS plans are a kind of hybrid. All of the details will be spelled out on a list.

Physicians/Hospitals
You’ll then be able to go online or order a directory to check out which doctors and hospitals belong to the plans. If you already have doctors you like, you can look them up and see if they participate. But beware: Not all the information is up-to-date. You might want to call your doctor and make sure before you sign up for a new plan.

Ratings
Now the real research begins. To find out how your plans rate, you’ll have to do a little digging, but there are consumer watchdog organizations out there to help you. Health Choices and the National Committee for Quality Assurance are two places to start.

-- The Nest Editors

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