Understanding Health Insurance (cont.)
IN THIS ARTICLE
Choosing a Plan
When choosing a health insurance plan, carefully consider the plan's rules and policies. Find out the cost of the plan (premium), what medical services are covered, how the payments work, and how much choice you will have when choosing providers and hospitals. Ask for a summary of the plan's benefits.
Read the plan's brochure closely before you sign up. Ask questions about parts you don't understand. It may be helpful to know these terms:
It's a good idea to contact your doctor's office to find out which health plans are accepted and how the payments work.
Coverage for medicines
Find out how your insurance covers medicine costs. Some insurance companies cover only generic medicines if they are available, rather than brand name medicines. With some plans, you may have to pay more for medicines that aren't on the plan's list of preferred medicines (formulary). Some insurers cover medicines that are bought only at certain pharmacies.
A formulary may put drugs into three groups, or "tiers," based on how much your health plan will pay and how much you will have to pay.
If you have a choice between plans, check what your co-pay for prescription drugs will be, the maximum amount the plan will pay in a year, and other details.
Some organizations, such as the National Committee on Quality Assurance (NCQA), give reports on insurance companies. This may help you choose which plan is best for you. Find out more at www.ncqa.org.
Questions to ask
When you are choosing a health insurance plan, think about questions you want to ask. For example:
After you have a plan
After you get a health insurance plan, keep your insurance card with you. Save your insurance company's phone number in your phone's memory so that you have it available.
Many plans require you to contact your insurance company before having an elective procedure, such as a surgery or certain medical tests, or for a hospital stay. If you have a medical emergency, get help for the problem first. After the emergency is taken care of, contact your insurance company as soon as you can.
eMedicineHealth Medical Reference from Healthwise
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