What to Consider When Picking a Plan

Cost can be a key factor, but you also need to consider quality and continuity of care.

If you have a choice of health plans, the one you select depends on what is most important to you. For a lot of people, cost is top on the list of things that matter when picking a plan. But you shouldn't just consider cost when selecting a plan. It also is important to consider your health needs and the quality of care you'll get with a plan.

Keep costs under control

With health insurance premiums on the rise, there's a good reason many Americans are concerned about the cost of their coverage. So when you're selecting a plan, be sure to ask these questions so you'll have a better idea how much you'll actually have to pay for health care:

-- Are there deductibles to meet before the plan starts covering costs?

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-- Once the deductible is met, what percentage of costs will the plan pay?

-- Are there co-payments?

-- What is the cost of seeing a doctor outside the plan?

-- Are there any limits on what the plan will pay?

If you're single and in good health, you can save money by opting for a low-cost, high-deductible plan that provides coverage primarily for major procedures. You can pair the high-deductible plan with a health savings account, which lets you save money tax-free for medical expenses. (See FAQs About Health Savings Account for more information). If you have small children, you might want to pay a little more for a plan with low or no co-payments so you won't have to shell out cash for the frequent visits to the doctor. If you or a family member have a chronic disease that requires expensive treatments, it's important to find a plan that covers your treatments, medications, doctors and the hospital you prefer to use.

Consider your health needs

For many people, especially those with a chronic illness, it's important to select a health plan that includes their current doctors in its network of providers to ensure continuity of care. Many people prefer to stick with their current provider if they are switching plans -- even if that means choosing a plan that might be a little more expensive. If your providers aren't in the networks available to you but you don't want to switch doctors, look for a plan (usually a PPO).

Furthermore, you're better off choosing plan that includes multi-specialty groups -- that is, a medical center with primary care physicians, specialists, surgeons and a laboratory all under one roof -- among its providers. You'll get better continuity of care -- especially if you have a chronic condition -- than if you go to different providers all over town.

Size up the quality of care

Unfortunately, there is no single consumer report on the quality of health care providers. But that shouldn't stop you from checking into the quality of care provided by health plans and the doctors, clinics and hospitals that are part of their networks of providers.

Check with state and federal regulators. In every state, health insurance is regulated by insurance commissions (Find your state's insurance regulator.) However, some states (Florida, to name one) are more organized about providing information to the public. There also are national organizations that accredit health plans, such as the Joint Commission on Accreditation of Healthcare Organizations, which accredits more than 16,000 healthcare organizations. Others include the National Committee for Quality Assurance, which accredits HMOs and other managed care organizations, and the Utilization Review Accreditation Commission, which accredits PPOs.

Check with the plan. Ask the plans if they survey members about health care experiences and whether they review qualifications of doctors. Find out whether physicians tend to stay in the plan, and ask the plan for biographies listing doctors' specialties and credentials. Most doctors with active practices are certified in their specialties by national boards. Check out the plan's reputation. Ask the plan for the names of members who can tell you how it rates with them. Be wary of any that refuse. Also ask for financial statements, which are an indicator of the organization's fiscal health.