Health plans -- ugh. My least favorite subject and more than
likely your least favorite as well. I'm not sure I've met anyone
who really likes to talk about them and I'm guessing it's because
most of us, myself included, don't fully understand them. HMOs,
PPOs, POSs, private/government plans, deductibles and co-pays; who
has the time or desire to even try to understand all that
mumbo jumbo? With all the current changes taking place in health
care, it is important to understand the basics so you can pick the
plan that's right for you and your family.
Terminology to Know
Co-payment - The fixed amount a plan requires
you to pay for certain services. For example, you might have to pay
$10 when you visit your doctor.
Deductible - The fixed amount a plan requires
you to pay for medical services before the plan kicks in. For
example, you might have to pay the first $200 of a hospital visit
before the insurance company starts paying.
Maximum plan dollar limit - The most a plan
will pay during a year's worth of coverage. Plans also have a
maximum amount it will pay over the course of your life (lifetime
limit).
Premium - The annual amount you pay monthly for
your health insurance plan.
Preparing for your Health Plan Search: Key questions to ask
yourself.
- How much money can I spend on health care?
This will determine how much you can afford to pay on premiums,
deductibles and co-pays.
- What pre-existing conditions do I have?
Certain health problems could make it more difficult to get an
individual health insurance plan.
- If I'm over 65, do I want more than the federal senior
health plan that assists with paying hospital bills and medical
treatment (known as Medicare)?
To help with non-covered expenses of Medicare, you may want to
consider a supplemental plan (known as MediGap).
- Do I belong to an organization or work at a business that
offers health insurance?
Group insurance is typically cheaper than an individual plan. Some
organizations like AARP offer plans.
Types of Health Plans and Providers
A large majority of people in the United States belong to
managed care plans because they offer lower co-payments when you
use doctors and hospitals that are part of the plan (known as
in-network providers). Manage care plans include:
Health maintenance organizations (HMOs) -
Except in medical emergencies, these plans require all your medical
care to come from providers in the HMO's network.
Preferred provider organizations (PPOs) - These
plans allow you to choose doctors and hospitals outside your
network, but you pay more due to higher deductibles and larger
co-payments.
- Your primary care physician manages your care in these plans,
but you are allowed to choose doctors and hospitals outside your
network, but you pay more for their services.
Assessing your Health Plan Options: Key questions to ask your
provider.
- How much are the monthly premiums?
- How much of the doctor and hospital bills will the plan
cover?
- How much are the co-payments and deductibles?
- Is your choice of doctors and hospitals extremely limited
or are there plenty to choose from?
- What happens when you need a doctor after business hours or
have to go to an emergency room?
- Are there limits on medical conditions or what the plan
will pay for certain medical conditions?
If you are eligible for Medicare, you can get supplemental
health insurance (known as MediGap). The National Association of
Insurance Commissioners has created 12 standardized MediGap plans
for seniors to choose between. Various insurance companies offer
the plans, so be sure to ask about MediGap plans when shopping
around.
Hopefully, I've not lulled you to sleep with this information,
but instead empowered you with this knowledge to ask questions and
take charge of your health plan.
For more information or help finding a health plan, contact:
U.S. Agency for Healthcare Research and
Quality
National Association of Insurance
Commissioners
AARP
Carrie Robertson
Research & Community Education
Chicago Senior Living
Assisted Living
in Chicago