Choosing a Plan

For most people in the United States choosing a health insurance plan traditionally has been as simple as accepting what their employer offered. There was only the one from which to choose, unless a person wanted to get individual coverage, which usually was too expensive. Over the past 25 years the landscape has changed drastically.

Over the years, the number of people covered by health insurance by their employer has dropped and the options and types of health insurance have increased. One policy no longer fits everyone and anyone with special health care needs should know the details of what is offered in each plan.

Good and Bad

This change in the way health insurance is offered can be viewed as a "good news, "bad news" proposition. While some so-called "cafeteria-style" or "a la carte" plans might make it more difficult or more expensive to receive certain services, others make it possible for someone to pick and choose needed benefits. Although no one plan might cover all needs, anyone seeking health insurance can find a plan that meets most of their needs, although the cost for some services might be quite high.

These options apply both to pay-for-service and managed care plans. Some of the basic information an insurance hunter needs to know is how the plans handle such issues as physical exams and health screenings, referral to specialists, hospitalization and emergency care, and prescription drugs. Other options to be researched and considered are services such as vision care and dental services.

Cost

With any health plan there will be a basic premium, which determines how much you or your employer pays, most likely on a monthly basis, to buy coverage. Traditionally, employers have paid most of or the entire premium, but this is changing also. In addition to the premium, there often are other payments that must be made, which vary by plan. Many plans also offer the option to cover spouses and children, again at an increased cost, especially if someone in the family has a chronic or serious health condition.

While with managed care, most of the costs are paid up front, there could be a much greater cost, or no benefit paid at all, for visits to physicians and other health care professionals not included in the network.

Fine Print

Because of this, those looking for health insurance should research the details and read the fine print of the plans. If there are specific health considerations to be considered, choose a plan with flexible options for referral to specialists. Also make sure to check for exemptions, cases where the insurance will not pay. For instances, some plans will not pay for unapproved doctor or hospital visits, even trips to the emergency room, if the plan administrators deem the visit unnecessary.

Also, check the plan offerings for waiting periods and specialized coverage, such as vision and dental coverage. Increasingly, even large companies are imposing waiting periods between the time an employee is hired and when benefits start, generally from one to three months. Other policies cover visits to the eye doctor or dentist, often also with their own waiting periods. For instance, some dental coverages impose a waiting period of up to 12 to 24 months before certain complex procedures (such as root canals or caps) are covered.

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