There are few things more important in life than health coverage. If you are looking to acquire or change health insurance, there are a number of critical factors that you will want to consider when choosing a plan. While cost is always an important factor, don’t let cost be the only thing guiding your decision. Think about the four “D’s” of health insurance any time you are evaluating your health coverage.
How much you pay for health insurance will directly impact how much you use it. Health care plans can be roughly divided into two categories, those with high premiums and those with low premiums. High-premium plans usually offer the most coverage and have the lowest out-of-pocket costs. Out-of-pocket costs are anything you must pay directly to a health care provider when you receive care. Such costs include copayments, coinsurance payments, and deductibles. Low-premium plans usually cost less upfront, but have higher out-of-pocket costs.
Which plan type is right for you will come down to your personality and your general health. People in good health often do well with low-premium plans because they don’t utilize health care services frequently. Their total costs (monthly premiums plus out-of-pocket expenses) are generally lower with a low-premium plan than a high-premium plan simply because they don’t use a lot of health care resources. Of course, having such a plan requires that a person have enough savings to cover deductibles and other costs. Low-premium plans can be more affordable unless something serious happens, in which case they can become very expensive.
When calculating the total cost of a plan, don’t just look at premiums and deductibles. Consider everything that you might have to pay should your health care needs suddenly increase (e.g. serious accident). Calculate your total out-of-pocket costs in a worst-case scenario (don’t forget prescription drugs) and look at whether there is an upper limit on how much you would have to pay before insurance kicks in to cover everything.
Just as important as cost in your consideration of health coverage is the care it entitles you to. What doctors and hospitals does the plan allow you to visit? Does your current doctor accept the insurance you are considering? Does the plan require you to get referrals to see a specialist or can you choose to see any provider you wish? Does the plan cover complementary and alternative treatments like chiropractic, acupuncture, or massage? In short, look carefully at the providers a plan allows you see and the facilities (hospitals, urgent care centers, etc.) that it allows you access to. Your health plan won’t be much good to you if you can’t see the doctors you want or need to see. Use online tools to compare providers and facilities if you don’t already know where you want to get your care.
The easier a plan makes it to get health care, the more likely you are to make use of the plan and thus the better your health will be. Consider anything that may impact convenience such as what pharmacy you can use, what providers you can visit, what hours the providers are available, if mail-order prescriptions are easy to obtain, and so forth. Consider your personality in this equation too. Will you go out of your way to get health care because doing so saves you money or are you better off spending a little extra each month to get convenience.
Prescription medications are one of the largest health care expenses that anyone faces and costs only tend to increase as we age. Ensure that your health plan includes coverage for prescription drugs and look at what your copay for medications will be. Figure out which pharmacies and pharmacy chains are covered as well. If taking name-brand medications is important to you, make sure you determine if you plan allows for the use of name-brand drugs or if it requires generic substitutions when they are available.
Pulling It All Together
Evaluating your options for health care is a process of elimination. Use the tips above to rule out any plans that you absolutely cannot afford or cannot tolerate. After you’ve done that, use the same tips to dig deeper into the remaining plans to determine what is most important to you. You may have to pay a little more to get the more convenient plan or you may be able to save money because a cheaper plan already covers the doctor you want to see. Take your time. Chances are good that you won’t be able to evaluate all of the plan options in a single day.