What should we consider when choosing our health plan?
When you’re weighing out health plan options, here are the key things to consider:
When you get your benefits package from your company, each plan will provide a prospectus listing the rate schedule for each option. Some companies pay 90 percent of the premium, some pay 50 percent, and others pay somewhere in between. You’ll be able to see what the copays are for office visits, prescriptions, and hospital visits, and whether you’ll need a referral to see a specialist.
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.
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 have doctors you like, look them up and see if they participate. But beware: Not all the information is up-to-date. Call your doctor and make sure before you sign up for a new plan.
To find out how your plans rate, there are consumer watchdog organizations out there to help you, like the National Committee for Quality Assurance.
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