The Nest

Monday, November 05, 2007 12:22 PM

How should we choose our health plan?

Before you get bogged down in figuring out your options, consider for a minute that if you’ve got choices for health insurance, you’re pretty darn lucky. How do you know if you do? You may have several alternatives if you and your spouse are working at full-time jobs and your employers offer choices for coverage. When you’re weighing out options, here are the key things to consider:

• Cost/Coverage

• Services

• Physicians/hospitals available

• Ratings by members

Cost: When you get your benefits package from your company, each plan will provide a prospectus listing the rate schedule for each option. Your companies may have very different contribution requirements – some companies pay 90% of the premium, some pay 50% and every variation in between. If you are planning on having a baby, make sure you look ahead and see how much family coverage will cost you.

You’ll be able to see what the co-pays are for office visits, prescription drugs and hospital visits and whether you’ll need a referral to see a specialist. If you are a frequent gym-goer, look for a plan that offers reimbursement. If you are planning on having a child soon, pay careful attention to the benefits for pregnancy and well-child visits-- many plans require no co-pay for those services. Also be sure to check out the mental health benefits, which can vary greatly.

Services: Look at the breakdown of services for each plan. This is when you’ll notice the real differences between Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and Point of Service Plans (POS). Each has a different way of approaching co-pays, referrals and deductibles. HMOs typically require you to only see doctors within a network, while PPOs are more flexible about going outside of a network, and POS plans are a kind of hybrid. All of the details will be spelled out in a list.

Physicians/Hospitals: You’ll then be able to go online or order a directory to check out what doctors and hospitals belong to the plans. If you already have doctors you like, you can look them up and see if they participate. But beware, not all the information is up to date. You might want to call your doctor and make sure before you sign up for a new plan.

Ratings: Now the real research begins. To find out how your plans rate, you’ll have to do a little digging, but there are consumer watchdog organizations out there to help you. Health Choices and the National Committee for Quality Assurance are two places to start.