How to compare plans, rates and options
If you have recently graduated from high school or college and are on your way into the workforce, you've got a lot of important decisions to make — including figuring out your health benefits options — to keep you feeling and looking your best. allaboutthebenefits.com gives you the information you need to make better health benefits choices.
Choosing a health plan can definitely be confusing. Who wants to read all the fine print? And who has the time to learn all of that terminology? Relax — there's a way to make everything easier. Ask yourself these questions to find a health benefits package to fit your medical and financial needs:
Doctors and networks
- How easily can I change my primary care physician? Can I see a specialist without a referral? Some plans require that you choose a main doctor (primary care physician or PCP) to coordinate all your care, meaning that you will need a referral from your PCP before visiting a specialist like a dermatologist or optometrist.
- If I see a doctor outside the network, will my plan cover my care? If so, do I have to pay extra? Think of in-network doctors and services as being in your cell phone's "Mobile-to-Mobile" calling plan. It's a preference thing. Sure, you can call people outside your plan, or see a doctor outside the network, but you'll pay more for it. Be sure to find out about your plan's "network" limits.
Chronic conditions and preventive and emergency care
- Does the plan pay for preventive health care? Things like immunizations and annual health screenings (for the girls out there that make the trip to the gynecologist for your annual pap smear) will likely be covered by health benefits.
- If I have a pre-existing medical condition, will the plan cover it? Some plans exclude coverage for pre-existing conditions, although this exclusion typically is waived if you have health insurance prior to joining the plan.
- If I have a chronic condition such as asthma, cancer or diabetes, what special services or programs are offered to me? Many plans offer specialized condition management programs that help you cope with a chronic condition. Check with your plan or your employer.
- What are the emergency care procedures? If you have an emergency condition at home or while traveling, seek appropriate care. Notify your plan as soon as possible after you receive emergency care so they are aware of the claim and can help you arrange follow-up services if required. Many plans apply a co-payment to emergency room services; some plans provide a reduced co-payment for care received in an urgent care center.
Prescriptions and extras
- Are the prescription medicines I use covered by the plan? You may also want to see if the plan offers a cost-efficient mail order prescription plan.
- Does the plan reimburse alternative medical therapies? Acupuncture, chiropractic treatments and other non-traditional medical services may be covered by the plan.
- What additional health programs does the provider offer? Many employers are increasingly looking at plans which offer wellness incentives, weight management and disease management programs.
What's the damage?
To figure out how much all of this is going to cost you, look at premiums, co-pays or co-insurance, deductibles and other out-of-pocket costs.
- Premiums are installments charged to you to pay for the health plan. This amount is usually taken directly from your paycheck.
- Co-payment and co-insurance amounts are your contribution — generally specified dollars or percentages — to cover doctors' visits and medical care. Fees are applied after you have met any applicable plan deductible, or fixed amount that you pay for before the health plan kicks in their payment.
- Other out-of-pocket costs (money that you fork over out of your own pocket, obviously) come from over-the-counter medicines, prescriptions, extra costs associated with seeing specialists and out-of-network doctors, etc.
