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Choosing the right health plan

6/23/2008

By Attorney General Roy Cooper
 
Health insurance used to seem simple. If your employer offered a benefit plan, you signed up for it. But these days, there are a lot of different kinds of health plans. Having a choice can be great, but it can also be overwhelming. 
 
Here are some suggestions to help make choosing the right health plan a bit easier:
 
  • Look at the big picture. Think about how you use your insurance, what you can afford to pay for your premiums, and what you could afford to pay for medical care. Look at the services you use most to help you estimate costs and select the right plan for you.
  • Frequency of care.Think about how often you need medical care.  You may have to pay a co-pay or coinsurance every time you visit the doctor. Do you and your family rarely need to see a doctor, or do you go to the doctor often?
  • Type of care. Think about what kind of medical care you need. Find out how much plans pay for the services you’ll use most often, and whether you’ll have to get prior approval for those services. For example, do you need rehabilitation therapy, mental health or chiropractic care? Will preventative medicine, maternity or prescription drug coverage be a major need in the coming year? The co-pays, deductibles and prior approval requirement for these services may be different.
  • Where you get care. Think about where you want to go to get medical care. Insurers will treat the same care differently depending on whether you get it at doctor’s office, an outpatient facility or a hospital. 
  • Find out if your doctor is in the plan’s network. Most insurance companies have a network of health care providers. If you use providers in their network, you’ll usually pay less. Check to see if your current doctors, pharmacy and other providers are in the network of the plans you’re considering. Ask your providers if they plan to continue to be in those networks.
  • Health care on the go.If you travel frequently, keep in mind that some plans have stricter requirements for getting prior approval when you’re out of state. This can be true even if you go to doctors or hospitals in the plan’s network. 
  • Costs. Once you know what kind of coverage you need, you can weigh the monthly costs versus the benefits offered. Generally, the more you pay in deductibles, co-pays and co-insurance, the lower your monthly premium should be. But before you choose a plan with high out-of-pocket costs, ask yourself what you can afford to pay if you get sick or have an accident. Make sure the low costs aren’t based on cutting services you may need.
 
There is help available if you need assistance deciding on a healthcare plan.  [Services provided by MCPA have been transferred to the Health Insurance Smart NC Program.] 
 
Attorney General Roy Cooper and his staff work to help North Carolina consumers make smart choices and get the most for their money. We are here to be of service when you need us, but through education efforts like these columns we hope to help consumers avoid problems from the start.