Deciding which health plan is best for you takes more than just determining the lowest sticker price.
That’s not to say that the premium — or monthly price you’ll pay for coverage — isn’t important. But there are other important factors to consider.
A key question is whether your favorite physicians and hospital are in the health plan’s network. If they aren’t, you are likely to pay out-of-network charges to use these providers. That can get very expensive. In other words, you may end up having to give up the relationship with a longtime doctor under some health plans.
Another consideration is the deductible. To hold down costs, many employers are raising deductibles — some to $1,000 or more a year. Typically the lower the premium, the higher the deductible.
Finally, there are the details of coverage. What benefits are offered by an insurance plan – and what aren’t — can make a huge difference in overall costs to you. If you”re planning to have a baby, or have an existing medical condition, or regularly visit a therapist, make sure you read the coverage details carefully. Some plans don’t pay for prescription drugs, mental health treatment and other services that you may be important to you. Many individual plans don’t cover maternity care .
You also want to review a health plan’s preferred drug list; if your medication is not on it, you’ll probably be charged more.
Definitions of key terms:
Co-insurance The money that you are required to pay for services, after a deductible has been paid. In health plans, co-insurance is often represented by a percentage. So if your employer or insurer pays 80 percent, your co-insurance would be 20 percent.
Co-pay A fixed fee that you pay for physician office visits, emergency room visits or prescription drugs, usually collected at the time of service.
Deductible The yearly amount you must pay for health care expenses before insurance begins to cover the costs.
Flexible spending account A benefit where you can put a portion of your paycheck in the account every year, tax-free, and then use it to pay for related expenses, including deductibles, co-pays, co-insurance, dental care, eyeglasses and contact lenses. But be careful: If there’s money left in the account at the end of the year, you lose it. And there are new rules restricting the use of this money for over-the-counter medications.
Health savings account (HSA) An investment account that you can tap for deductibles and other health expenses without incurring taxes. Unused HSA money rolls over every year. These accounts are accompanied by high-deductible health plans. A similar arrangement is a Health Reimbursement Account.
Pre-existing condition A medical condition that may result in a health plan limiting or denying coverage or benefits. The exclusion on covering this condition may continue for a specific period of time or indefinitely.
Premium The monthly payment you make for insurance coverage. For some families without job-based coverage, the premiums can be $2,000 a month or more.
The U.S. Department of Health and Human Services has a web-based tool to help you evaluate health plans in our state and others. It asks whether you’re seeking coverage for only yourself or are looking for a family plan. It gives you the base premium, or sticker price, for a range of health plans in your area. This allows you to compare plans by premiums, deductibles and coverages.
Here is the link.
Also, a state government website provides some quality of care and patient satisfaction numbers for various health plans in Georgia.
Here’s the link.