Choosing the best health insurance plan involves the following:
Finding the health insurance plan with the lowest cost (but only with respect to the other two criteria).
Finding the health insurance plan with a network that meets your needs.
Finding the health insurance plan with coverage that meets your needs.
Choosing the right health insurance policy involves finding the lowest price amongst the policies that meet your needs as to network and coverage. Choosing the lowest price is of course very easy.
Determining whether the health insurance plan’s network of doctors meets your needs is only a little more difficult. Choosing a health insurance policy that covers you well can be complex.
Most of this article focuses on this area. I’ve been a health insurance agent since 1985 and have helped many families find affordable health insurance. These are the strategies that I use when helping a family find good medical coverage in my home state of Connecticut.
To help find out what health insurance plans are available and approved in your area, I’ve put together a list of Insurance Departments for each state.
Choosing the Health Insurance Plan with the Right Network
Most companies have websites that will list the doctors and hospitals that participate in their plan. All that I’m aware of will have a printed list that they can mail to you.
The right plan will have your doctor on their list or at least doctors who serve your home area. If you travel it is important to find a plan that covers you well in other geographic areas as well.
Choosing the Health Insurance Plan with the best coverage
Health insurance contracts may be the most complex of the insurance policies purchased by the average family. Understanding how your health insurance policy will pay for your medical bills can be difficult. Fortunately most of the brochures and outlines of coverage that you may receive from a health insurance provider will have a similar structure.
They will have sections similar to the following: What is Covered? Health Plan Exclusions and Limitations What is Covered?
This section will detail what medical procedures your health insurance policy will cover. The policy should have a phrase like “reasonable and customary” or “usual, reasonable and customary” or something similar when describing how much they will cover.
Watch out for health insurance policies with:
Dollar amount limits for each procedure
A long list of procedures that the health insurance policy will cover Better health insurance policies will not list dollar amounts for each procedure. They will pay using a formula that is based on what other doctors or medical providers will charge you in the same geographic area. A phrase like “usual and customary” indicates that they use such a formula. The cost of medical care rises so quickly that a dollar amount that seems impressive today may not fully reimburse you even a year from now.
Solid health Insurance policies will not have a long list of procedures that they will cover listed on the policy. The long list seems impressive because the list takes up a lot of space. Look at the statements below. It should be easy to choose between one and two.
“Our health insurance policy will cover you for everything except for expenses caused by self-inflicted injuries and substance abuse.” (“I’ve been to every state in the union except Alaska.”)
“Our health insurance policy will cover your nose, your ears, your toes, your hands, your right lung, your calf and your knee” (“I’ve been to New York, Connecticut, Nebraska, Washington DC and Vermont”)
Health Plan Exclusions and Limitations This section will tell you what is excluded. Typically elective surgery will not be covered. Also experimental procedures and expenses caused by self-inflicted injuries will not be covered.
You should understand each of these exclusions and limitations before you commit to a policy.
Most policies will not include maternity insurance, so if you want to get pregnant, make sure that you know how your policy will cover maternity expenses. Unfortunately, maternity insurance is not available in many states except as part of a group insurance plan. To summarize:
* Determine what health insurance plans will cover you in your area
* Determine which health insurance plans offer adequate coverage
*Choose the plans that offers the best value based on price and coverage