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Ask yourself these questions:
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How comprehensive do I want coverage of health care
services to be?
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How do I feel about limits on my choice of doctors or
hospitals?
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How do I feel about a primary care doctor referring me to
specialists for additional care?
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How convenient does my care need to be?
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How important is the cost of services?
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How much am I willing to spend on premiums and other health
care costs?
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How do I feel about keeping receipts and filing claims?
You might also want to think about whether the services a
plan offers meet your needs. Call the plan for details about coverage if you
have questions. Consider:
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Life changes you may be thinking about, such as starting a
family or retiring.
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Chronic health conditions or disabilities that you or
family members have.
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If you or anyone in your family will need care for the
elderly.
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Care for family members who travel a lot, attend college,
or spend time at two homes.
How Do I Compare Health Plans?
After you review what benefits are available and decide
what is important to you, you can compare plans. Many things should be
considered. These include services offered, choice of providers, location, and
costs. The quality of care is also a factor to think about.
Services
Look at the services offered by each plan. What services are limited or not
covered? Is there a good match between what is provided and what you think you
will need?
For example, if you have a chronic disease, is there a special program for that
illness? Will the plan provide the medicines and equipment you may need?
Find out what types of care or services the plan won't pay for. These usually
are called exclusions.
Few indemnity and managed care plans cover treatments that are experimental. Ask
how the plan decides what is or is not experimental. Find out what you can do if
you disagree with a plan's decision on medical care or coverage.
Choice
What doctors, hospitals, and other medical providers are
part of the plan?
Are there enough of the kinds of doctors you want to see?
Do you need to choose a primary care doctor?
If you want to see a specialist, can you refer yourself or must your primary
care doctor refer you?
Do you need approval from the plan before going into the hospital or getting
specialty care?
Location
Where will you go for care? Are these places near where you work or live?
How does the plan handle care when you are away from home?
Costs
No health insurance plan will cover every expense. To get a true idea of what
your costs will be under each plan, you need to look at how much you will pay
for your premium and other costs.
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Are there deductibles you must pay before the insurance
begins to help cover your costs?
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After you have met your deductible, what part of your costs
are paid by the plan?
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Does this amount vary by the type of service, doctor, or
health facility used?
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Are there co-payments you must pay for certain services,
such as doctor visits?
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If you use doctors outside a plan's network, how much more
will you pay to get care?
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If a plan does not cover certain services or care that you
think you will need, how much will you have to pay?
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Are there any limits to how much you must pay in case of
major illness?
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Is there a limit on how much the plan will pay for your
care in a year or over a lifetime? A single hospital stay for a serious
condition could cost hundreds of thousands of dollars.
You can't know in advance what your health care needs for
the coming year will be. But you can guess what services you and your family
might need. Figure out what the total costs to your family would be for these
services under each plan.
» Continue to - How Do I Find Out About Quality?
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