Be sure to compare:
1. Premiums.
2. Coverage/benefits.
3. Access to doctors, hospitals, and other providers.
4. Access to after hours and emergency care.
5. Out-of-pocket costs (coinsurance, copays, and
deductibles).
6. Exclusions and limitations.
Even if you do not get to choose your health plan—for example, if your employer offers only one plan—you still need to understand your coverage. What kind of services are covered by the plan? What steps do you need to take to get the care you and your family members need? When do you need prior approval to ensure coverage for care (for example, elective hospitalization for scheduled surgery)? How are benefits paid; do you have to submit a claim? Make sure you understand how your plan works. Don’t wait until you need emergency care to ask questions.
If you are choosing between indemnity and managed care plans, remember that they may differ in several important ways, including:
• How you access services.
• How you obtain specialty care.
• How much and sometimes how you pay for care.
