Navigating the Health Care System: Choosing a Health Plan
Debra: Choosing a health plan can be confusing. Some people ask their friends, family or co-workers for advice. But how do you really weigh your options and make an informed decision? AHRQ Director Dr. Carolyn Clancy has some tips for navigating this part of the health care system. Thanks for joining us, Dr. Clancy.
Dr. Clancy: You’re welcome.
Debra: First, I’d like to hear your advice on how people should start when they’re trying to figure out which health plan is right for them?
Dr. Clancy: First, consider how much coverage you need. Are you single or do you have a family? Do you or a family member have a chronic condition? It’s important to look at what coverage you will get for doctors’ visits, surgery, hospital stays or other types of care. And it’s important to know does your plan cover prescription drugs, visits to the dentist, new glasses, and so forth.
Debra: What about cost? Should it be a factor in the decision?
Dr. Clancy: The cost of insurance is an important issue. You need to understand up front how much you will pay for your coverage in premiums. How much you’re able or willing to pay each week or month may determine what you get in benefits.
Debra: What if you have a lot of options and are confused about how do you narrow down your choices?
Dr. Clancy: The basics are consistent. You need to know what types of doctors’ visits, surgery or hospital services are included in the plan. You need to know does the plan include prescription drugs or visits to the dentist or eye doctor? And, of course, you need to know how much you’re going to pay out of pocket, if there is a co-pay or deductible you need to meet, or if there’s an overall limit or cap on benefits. The bottom line is it’s important to know how the plan works. Don’t wait until you need health care to ask those important questions.
Debra: And, on the opposite end of the spectrum, what if your employer offers only one health plan or you’re self-employed?
Dr. Clancy: Even if you don’t have a choice of health plans, you need to know what your plan covers, the fine print. If you’re employed, you can talk to your employee benefits manager. If you’re self-employed, you’ll need to go to the insurance company or an agent for information. It takes some homework, sometimes a lot of homework, but it’s worth it.
Debra: For more information on how to choose a health plan, get the booklet "Questions and Answers about Health Insurance," available online at www.ahrq.gov/consumer/.