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Your Health Plan Affects Many Things
What Are Your Choices?
Rate Your Health Plan Choices
Today there are more health plans to choose from than ever before. Not
everyone has a choice. But if you do, this section can help you choose
the plan that will help you find the right urologist or nephrologist.
Do not assume that plans cover or provide certain items. Ask for any specifics you may
think of before choosing a plan.
Your Health Plan Affects Many Things
- Who will care for you (doctors and other health care providers), and how much choice you will have.
- What kind of care you will receive (for example, which preventive services are covered?).
- Where you will receive your care (which hospitals, for example).
- When you will receive your care (will you receive it when you need it?).
- How you will be cared for (the quality of care you receive).
- How much you will pay
The two major types of health plans are "fee-for-service" and "managed
care."
Managed care plans can go by many names: Health Maintenance
Organization (HMO); Preferred Provider Organization (PPO); Individual
Practice Association (IPA); and Point of Service (POS) plan, to name a
few.
What you need to understand is not the plan's label, but the
characteristics of the plan. Research shows that it is important to
understand your options and how they affect your choice of providers
and services, costs, and quality of care.
Before you join a plan, it is good to get consumer ratings or consumer satisfaction information. Here are some questions to consider regarding the quality of a particular plan:
- Is the plan accredited?
- Do members get the health services they need? Without long waits?
- How easy is it for members to get a doctor they are happy with?
- How easy is it to see a specialist?
- Do doctors in the plan listen carefully?
- Do they explain things well?
- Are office staff polite and helpful?
- Is the health plan's customer service good at giving information and helping with problems?
- Do members have too many forms to fill out?
- How do members rate the care from the doctors and other health care providers in the plan? How do they rate their plan overall?
- Does the plan provide preventive services to help keep people well?
- Does it do a good job of helping people get better when they are sick?
- Does the plan have the doctors and hospitals I want or need?
- Will the plan allow you to stay with the doctors you currently go to without paying extra?
- Will the plan allow you to stay with the hospitals you currently go to without paying extra?
- Do the doctors, pharmacies, and other services in the plan have convenient times and locations?
- If there is a deductible, how much will I have to pay before the plan starts to pay for medical care or prescription medicines?
- How much will I have to pay (co-payment) each time I visit a doctor, hospital or pick up a prescription?
- How much more will I need to pay if I go outside the health plan's network of doctors, hospitals, and other providers to get services?
- How much will the premium cost me each month?
- Cancer screening (colorectal cancer tests, mammograms, Pap smears, etc.)
- Cholesterol screening
- Immunizations (shots)
- Prenatal care
- Baby care
- Care for a pre-existing condition (one you have before joining the plan)
- Diabetes supplies
- Dental exams/treatments
- Eye exams/glasses/contact lenses
- Hearing exams/hearing aids
- Outpatient prescription medicines
- Medical equipment for use at home
- Mental health services
- Physical therapy
- Hospice care
- Counseling to stop smoking
- Drug and alcohol counseling
- Alternative treatments (such as acupuncture or chiropractic services)
- Home health care
- Adult day care
- Nursing home care