Choosing the health plan that is right for you and your family can be a little tricky considering the many variables that have to be kept in mind. Not only you need to make a good choice in terms of coverage but also avoid some common mistakes that people usually make. Unless you have the right insurance package, it can prove to be a very costly exercise if you or any of your family members fall ill.
The Plan Coverage
Insurance purchased by people and small businesses will almost always cover some mandatory things such as emergency services, laboratory tests, hospitalization, maternity and care for the newborn, treatment for substance-abuse and mental health issues, treatment for children, including vision and dental, prescription drugs, outpatient treatment, prevention of disease such as mammograms, immunization programs and chronic disease management like diabetes. It also covers rehab services. Older plans purchased before the 2014 health reforms laws came into effect may not have all the coverage mentioned, but you will be informed by the insurance company before the renewal date and you can then exercise your option to switchover or retain the existing plan.
Make full use of online comparators and reviews about the services provided by the different insurance companies before purchasing any plan. It is wise to make for yourself a checklist containing all the coverage that you think is essential. If there are concerns regarding cardiac health in your family, then you should necessarily be considering only plans that provide for cardiac disease treatment, including screening, medication and surgery. The Affordable Care Act makes it mandatory for insurance plans to cover the complete cost of a number of preventive services including test and medication for high blood pressure, colon cancer, high cholesterol, diabetes, etc. when the services are provided by a doctor included in the plan coverage. Trendhunter.com’sviews on DMR’s is a particularly good resource on news and emerging trends in the health care sector.
The Plan Cost
Health insurance has two cost components. One is your monthly premium and the other is the out-of-pocket expenses that you incur while being treated. Typically, higher the premium, the lesser are the expenses. If the coverage is purchased through the Health Insurance Marketplace of your state, you may become eligible to receive subsidies that reduce the premium and sometimes the expenses. The subsidy is dependent on your income. Comparison of the plans on offer is made easier as they are classified into certain standardized structures that specify how much of the purchaser’s total cost of health care will be covered and how much they average out-of-pocket expenses are likely to be. The plans are termed as Bronze, Silver, Gold and Platinum with coverage being 60, 70, 80 & 90%. The deductibles are of the order of $5,081, $2,907, $1,277, and $347 as per a privately-conducted study. The plan you buy should be against your perception of your health risk and the state of your finances.
Network Coverage and Other Issues
If you have a physician that you are comfortable with or a specialist who is conversant with your medical condition, you should ensure that they are covered in your insurance plan network. If your doctor is not included in the plan’s network, the bill may not be covered or you may be saddled with a much higher cost-sharing amount. You should be doubly careful that the network includes your doctor; else the consequences could be very expensive.Before purchasing any particular plan, you should also verify that the drugs you need to take, especially the more expensive ones, are included. Remember to include your dependents. The law permits children who are below 26 and not receiving health coverage from an employer to be included in your plan. Insurance plans also cannot exclude those under 19 years of age due to any pre-existing condition.Go online and check out the various comparison charts that have been designed to make your life easy. Take a tour of each plan to discover its main benefits and get an idea of the applicable premium and the cost-sharing. If you still want to talk to a real person you can locate any of the registered brokers and insurance agents for advice. The recent HFA.co.in guide on managing your family’s health is also a useful resource for the selection of an appropriate health insurance cover.