People who are on health insurance shopping spree should very well know that one size doesn’t fit all. First-of-all people need to carefully access their healthcare needs and then head to shop for a health insurance plan. People are not only advised to go through the fine print of health insurance plan but they should also spend some painstaking time on research before buying so that they don’t end up in a nasty financial headache after it becomes too late. No matter, people are looking to enroll in a group health plan offered by their employer or shopping for an individual health plan, the following seven points checklist will prevent them from enrolling in the worst health plan.
The doctor is in the Network
While shopping for health insurance, the first thing that people need to pay attention to is to make sure that their preferred doctor, other healthcare professionals of their choice are included in the plan they wish to enroll. People also need to ensure that their preferred specialist is also included in their plan, and they should not assume that their preferred specialist is included in their plan network just because the specialist was recommended by their primary care doctor. A health plan that strictly restricts people to a local network might prove sufficient for people who do not move out but for students who have to move away to study or people who frequently travel and stay in different locations will not find such a plan beneficial for them.
Don’t Pay Huge Premiums to Save Few Bucks on Copay
One common mistake that is made by individuals while shopping for health plans is that they greatly focus on getting a low copay and fail to recognize the extra premium which they pay for it. First people need to evaluate the way they will use the plan and them accordingly compare the costs. People who pay a visit to a doctor only a couple of times in a year should not spend hundreds of dollars extra on the premium to get a low copay.
Prescription Drug Coverage
Individual health plans in some of the states cover prescription drug coverage whereas some of the states don’t cover prescription drug coverage. If people are looking to buy a plan that provides prescription drug coverage, then they should make sure that the medication taken by them are included in the plan’s formulary. This is essential to check because if drugs taken by them are not included in the plan’s formulary then they will have to pay more for it. Besides the plan’s formulary, people also need to check whether the plan provides discounts on the bulk-online ordering of drugs or not. For example, they may be able to pay less per month for a 90-day supply of drugs through online order compared to a 30-day supply at the local pharmacy counter.
Don’t be Over Insured
Besides having a comprehensive health insurance plan, many people might be having supplemental health plans like cancer or critical health insurance plan. These plans do provide valuable protection, as these plans pay a lump sum amount after diagnosis but at times these plans might be unnecessary if people have comprehensive coverage under medical insurance, short-term insurance, or long-term disability insurance. If people have to foot even a part of the premium, then they might be paying for coverage that they don’t need.
Check Out-of-pocket Expenses
An attractive feature of High-deductible health plans is low premiums but before falling for these plans people need to make sure that they can pay out-of-medical expenses of these plans. People should also check the maximum amount that they have to pay after meeting the deductible. Most of the plans only pay a part such as 70% of the covered medical expenses and the remaining 30% of the cost have to be paid by the people in the form of coinsurance until they reach the cap on their out-of-pocket expenses. These amounts can be huge and so people need to consider these aspects before selecting a health plan.
All Expecting Women should ensure Maternity Care is Included in Plan
Due to the federal Pregnancy Discrimination Act of 1978 and the Health Insurance Portability and Accountability Act of 1996, as well as many state health insurance mandates for group coverage, many employer-sponsored health plans include maternity and prenatal care. Some of the states have even mandated for individual health plans to include maternity coverage but the states where there is no such mandate, many plans either don’t include this benefit or they pay only a small portion of the costs. Even if the plan includes maternity benefits, women should make sure what exactly is covered and whether there is any cap on the amount received or not. However, starting from 2014 all individual and small group plans sold through state health insurance exchanges should include pregnancy and newborn care along with other essential benefits.
Review Group Health Plan
People every year during open enrollment need to review their group health plans offered by the employers. People should not simply assume that their plan will remain the same. There is a possibility for the coverage level, costs, and network of the plan to change from year to year, even if the plan is offered by the same insurer. Thus, people should every year carefully review the plan to ensure that the plan is still offering the same coverage for which they have enrolled in the plan.