Evaluate Your Health Plan

Whether you have a health plan that is too limiting with many denials, or you currently do not have insurance, consider searching for a new plan by reviewing the guidelines below.

When considering a health plan purchase, determine if the plan offers the benefits and coverage you need, evaluate the health plan's ability to offer you a variety of Choices for Physicians, should have Coverage for the required medical treatment you or your family need and has Costs which are affordable.  

Choice

Are you able to see your desired physician, hospital or other medical provider as part of your plan?   What is your availability to choose your physician or medical provider and do you have to obtain permission for seeing a specialist? How much approval do you have to get from your primary care physician or health plan before seeing a medical provider or specialist?


Some health plans are very restrictive in  your selection of medical provider.  If you feel you need more of a choice in selecting medical providers then you should consider changing plans, unless costs significantly outweigh choice of physician.

Coverage

Are you able to use your health plan to cover needed services and medical treatment?  Are there very much restrictions on the types of coverage and benefits offered?  Do you require and does your current plan offer coverage for the following services:

  • Maternity coverage
  • Prescription coverage
  • Well child care
  • Immunizations
  • Annual physicals
  • Dependent coverage
  • Specialists coverage (i.e. home care, hospitalizations, vision, dental, speech, etc.)

Some health plans, in order to reduce the costs associated with a plan, will limit the benefit coverage for certain types of services and medical treatment.  If you feel that your health plan does not cover many of the needed medical services for you to be healthy and to live a quality life, then you should consider changing plans, unless costs significantly outweigh availability of coverage.

Cost

Costs are usually the overriding factor of the health plan most consumers select.  However, if you utilize a physician or medical provider frequently and you will be needing the use of your health plan more often, or you have a serious illness which requires treatment, then it may be better to select a plan with lesser restrictions.  However, if it is difficult to obtain the plan you want, then you should consider modifying one of the following elements to find an affordable premium with the coverage and choice of physician selections you require in a plan:

  • The type of plan you choose (Traditional Indemnity, HMO or PPO)
  • The amount you accept for your deductible, coinsurance and copayment
  • The lifetime maximums you decide on
  • The extent of benefit coverage on the plan

The more restrictive the plan (HMO, EPO), the higher the deductible and coinsurance rate, the less of a lifetime maximum and a reduced level of benefits will give you a plan with the lowest costs, but it may not be the most practical plan to purchase.  You must consider all of these options carefully.  An insurance agent could assist you through this process.  If you would like to receive a free health insurance quote to compare against your current plan, please visit insurance quotes page.