Considerations When Comparing Health Care Plans

Finding affordable health care can be tricky. Determining which plan gives you more of what you need for a better price among available options can feel like comparing apples to oranges. If you need to choose between different health insurance plan options, the following are some key factors to keep in mind.

The Health Care Network

Most health insurance plans in Harrisburg coordinate with a network of providers, which includes individual doctors, hospitals, and other medical facilities. The insurer has negotiated a lower price for care from in-network providers, so insured individuals can expect to pay less for medical care from in-network providers.

The health care network available to you through your insurance may be one of the most important considerations for both expected cost and level of care. If you have an established relationship with a doctor, you likely will want to find a health insurance plan that includes that doctor in its network so you do not have to pay a premium to continue seeing the physician.

You can compare available doctors in various networks by researching potential doctors’ credentials, by reading online reviews on reputable sites, and by checking with the American Medical Association (AMA).

Your insurance plan also will include hospitals and emergency medical centers in the network. Comparing which hospitals are part of each plan’s network can help you determine which insurance will best serve you in case of an emergency. Which plan offers multiple options for local hospitals?

Don’t forget to check how each plan defines “emergency care.” If there is a threshold in terms of patient condition, deductible, or procedure coverage you need to meet for emergency care for your insurance coverage to kick in, you will want to know this before dealing with a serious injury or illness.

Specialists

If you have specific medical conditions or believe you may need to see specialists in the future, find out if you will be able to see a specific specialist, and what the procedure is. Some health care plans require a referral before you may see a specialist, and other types of health insurance do not. If you already have a specialist, see if they will be accepted by the insurance company you’re considering.

Costs

Unfortunately, the cost of health insurance is not a simple calculation. Not only do you have to compare premium prices, but you also have to understand the out-of-pocket costs, including deductibles, copays, and coinsurance.

Premiums

This is the monthly payment you make to your insurer for your health care plan. In general, lower premiums are associated with higher deductibles, copays, coinsurance, and prescription drug costs. That means a lower-premium health care plan may be a good choice for someone with few existing health care needs, as they are less likely to require the care that will result in out-of-pocket costs.

Deductibles

Most insurance plans require the insured individual to pay a certain amount before coverage kicks in. For instance, let’s say your health insurance plan has a $1,000 deductible, and you need to have a covered procedure that costs $2,500. If you have not paid for any medical services yet this year, you will have to pay $1,000 toward your covered procedure; your insurance will cover the rest—at the level laid out by your plan.

Copay and Coinsurance

There are two ways an insured individual is responsible for a portion of the cost of their care. The first is through a copayment. This is a fixed amount of money you pay toward your care after you meet your deductible.

Lifetime Limits

In addition to the out-of-pocket costs that you need to consider as you compare insurance plans, you will also need to check on the lifetime limits for each plan. This limit is the cap on benefits you can receive from the health care plan for any covered services.