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Choosing the Right Health Plan
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HMOs and PPOs tend to cost less as long as you use their in-network doctors and hospitals. |
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If you receive healthcare coverage through your employer, chances are you have an annual “open enrollment period.” This is a time when you can choose to continue with your current coverage or switch plans.
Most people dread having to read the paperwork involved in choosing a health plan. But the choice they make is critical.
Shop Around
To compare health plans, start by obtaining a coverage statement and list of doctors/ providers for each plan. The coverage statement spells out what is and what is not covered by the plan. This includes premiums, co-payments, deductibles and any annual or lifetime limits on how much either the patient has to pay or how much the plan covers.
With information on health plans in hand, three basic questions are important:
- How big a factor is price? Compare how much you would pay monthly for each plan and how much you would pay out of pocket for medical visits. Typically, if you sign up with an indemnity plan — which allows you to see any doctor or hospital — you end up paying the most. Health maintenance organizations and preferred provider organizations tend to cost less as long as you use their in-network doctors and hospitals.
- Will your particular medical needs be covered? If you have a preexisting condition, such as diabetes, make sure the plan covers that.
- Do you want to continue existing relationships with specific doctors or hospitals? If you’re already attached to a doctor or hospital, you’ll want to know whether you can continue these relationships.
Memorial Hermann Healthcare System accepts most major health plans. For a list of all insurance affiliates accepted by Memorial Hermann, visit the For Patients page at www.memorialhermann.org
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