1. Your Doctor: Some health care plans require you to
use their network of doctors. If you currently have a physician who you would
like to keep seeing, check to see if your doctor is included in the health care
plan you are considering. If you need to choose a new doctor from the health
care plan, consider researching a doctor's credentials by reading online doctor
reviews. Location and availability are other factors to consider when choosing
a doctor.
Find out the
hours of the facility where the doctor works and see if the doctor is available
all of those hours or only a few.
2. Specialists: If you have specific medical
conditions or believe you may need to use specialists in the future, find
out if you will be able to use a specialist and what the procedure is. Some health
care plans require a referral before you can see a specialist and other types
of health insurance do not. If you already have a specialist, see if they will
be accepted.
3. Waiting Periods: Sometimes in the confusion of
choosing health care plans, you may forget to confirm how pre-existing
conditions will be covered and whether there are waiting periods that will
impact your current care. Make sure to review these details.
4. Emergency and
Hospital Care:
Find out what emergency rooms and hospitals are covered on your plan. In
addition, find out how the policy defines an “emergency.” Sometimes your
definition of an emergency may not be the same as the health care plan you are
considering. Check to see if you need to contact your primary care physician before
getting emergency care.
5. Regular Physicals
and Health Screenings: If
you like getting regular physicals and health screenings, find out what will be
covered as part of a wellness plan or what is included in preventative care,
and if there are any limitations. If you have children find out if well-baby
check-ups and immunizations are covered.
6. Prescription Drug
Coverage: If
you currently use prescription drugs on a regular basis or think you may need
to in the future, check the details of prescription drug coverage. This
coverage type can vary a lot from plan to plan.
7. OB-GYN: If you regularly see an
obstetrician or gynecologist, find out if your doctor is covered in the plan
you are considering. If you are considering fertility treatments or will in the
future, see what may be covered as some plans are now including varying types
of fertility coverage. The same would apply for pregnancy coverage, find out
how much you will have to pay out-of-pocket for pregnancy and birth care if you
are pregnant or decide to plan to get pregnant in the future.
8. Additional
Services: Consider
what additional services are covered when comparing health plans. Some examples
of additional services that may be important to you include: drug and alcohol
rehabilitation, mental health care, counseling, home health care, nursing home
care, experimental treatments, alternative treatments, chiropractic care.
Keep in mind that there are
also policies like critical illness or long-term care insurance that you may
want to look at while you evaluate your health insurance options. These are
considered supplemental health insurance.
9. Costs: Find out what deductibles you
will need to pay before the health care policy will pay. Learn what percent the
health care will pay after your deductible, as well what percent they will pay
if you need to use a doctor, hospital, or specialist that is out of network.
Find out if there will be co-payments. These are the fees you need to pay when
visiting your doctor, hospital, or emergency room. Finally, know your limits.
Some plans have lifetime limits on how much the health care plan will pay and
some have lifetime limits along with yearly limits.
10. Exclusions: The last consideration is the
exclusions list. You will want to review each plan’s exclusions list to find
out what is not covered so you don't have any surprises once you have selected
your health insurance options.
