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. If you're seeking out your own insurance and need affordable options, evaluate the plans through the government's marketplace, using HealthCare.gov. You can apply during open enrollment, which begins in November and lasts a few months, or if you experience a life change, such as you lose your job, get married, have a baby or even move, you could be eligible to sign up though that special enrollment period.
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. If you don't visit the doctor often, you might choose to opt for a high deductible plan with a health savings account (HSA), because you can put tax-free dollars in a special account, and it can earn interest and grow (hello, free money). 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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