Benjamin Franklin once said, “In this world nothing can be said to be certain, except death and taxes.” Today he might add “health insurance confusion” to his list of certainties, for despite the government’s best reform efforts, choosing a new healthcare plan is still proving to be a difficult process for many. While monthly premium and plan deductible are often top-of-mind considerations, consumers should give other less obvious details equal thought when making a selection. If you are considering new insurance coverage, scrutinize the following particulars and take the guesswork out of enrolling in the right plan for your situation.
Your Prescription Drugs
Health insurance plans cover prescriptions in different ways. While some may charge you a fixed amount (or co-pay) for a prescribed medication, others will ask you to pay a portion of the drug’s cost in the form of co-insurance. Brand name medications may be covered (usually at a higher cost) through some plans and not at all under others. And if you purchase lower cost coverage, you may have to satisfy a prescription drug deductible before you receive any medication benefits at all.
If you regularly take medications, verifying coverage under the programs you are considering is a worthwhile step. Contact a plan pharmacist and provide him with a list of the drugs and dosages. Then look for an insurance product that covers the medications you need.
Your Doctors and Specialists
Many insurers reduced the number of doctors within their new healthcare plan networks. Before you select coverage, you’ll want to make sure your doctors—and any specialists you regularly see—are part of that plan’s network. You can do this by visiting the insurer’s website and searching for doctors within the program you are considering. You can also call the offices of your medical professionals and ask if they accept a particular plan.
Be specific when making enquiries. While a doctor may be part of the “Preferred Platinum Plan” network under Insurance XYZ, he may not be included in the network for XYZ’s “Premier Gold Plan.” Additionally, a doctor with multiple office locations may be in-network at some and out of network at others.
Doctors and Specialists in General
Maybe you don’t currently have a preferred doctor or see any specialists. You should still examine the number of professionals within each plan network. If you choose a health insurer with a small network—and very few doctors or specialists—you will find yourself waiting longer to schedule appointments. Instead, look for a program that has a larger number of providers. And remember: inclusion on the network list doesn’t necessarily mean a doctor is accepting new patients. You may want to call a few of the professionals to verify that they will.
Health insurance plans also have network hospitals. You’ll pay less if you go to one in-network and more if you receive treatment out of network. Because time is of the essence in the case of an emergency, you may want to consider the location of in-network hospitals when selecting insurance coverage. Hospitals near your home or place of business are ideal; those further away are not.
Cost is also a factor. Some plans will charge you daily in-patient co-pays, while others will ask you to pay co-insurance towards the room charge. To determine which deal is better, you may want to call a network hospital and ask about room rates.
If you’d prefer to choose your next health insurance program with the assistance of a professional, consider contacting your insurance broker or agent.