Insurance plans vary. Before choosing a plan, decide what is most
important to you. This checklist can help. Put a check in front
of those services that are important to you. Then see how many of
these services are in Policy #1, Policy #2, and Policy #3. On the
checklist, write in the coinsurance or copayment rate, if there
is one, and any limits on service.
Remember that the most important service to be covered is hospitalization.
If you are not covered for hospital care, then one sickness could
cost you thousands of dollars, even hundreds of thousands of dollars.
| Use this work sheet to compare the costs of health insurance plans. |
Plan A |
Plan B |
Plan C |
| 1. What is the annual deductible? |
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For an individual
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For a family
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| 2. What is the annual premium?
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For an individual
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For individual and spouse
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For individual and family
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For a family
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3. What is your co-payment each time you use a service?
(To estimate your annual cost, multiply the co-payment
by the number
of times you expect to use the service
during the plan year.)
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Physician visit co-payment
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Hospital visit co-payment
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Prescription co-payment
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Other services co-payment
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4. What is the maximum amount you may pay out-of-pocket
in each year or a lifetime?
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5. What percentage of the cost will you be responsible for after you reach
your deductible?
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6. What will you pay if you use providers outside the health plan’s
network?
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7. How much will services not covered by the plan cost you annually?
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8. Are there limits on days or services covered or the amount
the plan will
pay each year?
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9. What is the limit on what the plan will pay for a major illness?
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10. What is the limit on what the plan will pay over your lifetime?
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Check Out The Company
Before purchasing any plan, make sure the company has a strong financial rating. Standard & Poor’s, Weiss Ratings, A.M. Best and Moody’s are independent agencies which evaluate the financial strength of health insurance companies.
You should also read the plan’s coverage contract, which may be called a “certificate of coverage” or “evidence of coverage.” It explains which services are covered and which are excluded in more detail than the summary of benefits.
No matter which health insurance plan you choose, you want to be sure you will receive quality care. To learn more about health care research and quality visit the Agency for Healthcare Research and Quality at www.ahrq.gov or the National Committee for Quality Assurance at www.ncqa.org.
Is the managed care organization accredited? Many managed care organizations choose to become accredited by one of several independent agencies. Accreditation provides a “seal of approval” and assurance that the organization meets a set of standards.
To find information on your state, call the National Association of Insurance Commissioners at (816) 842-3600 or visit www.naic.org.
Before choosing any health plan, make sure that it is convenient for you and your family.
- Where are the physicians’ offices located?
- How easy is it to get an appointment and how quickly can you get an appointment?
- Does the physician reserve some time each day for emergencies or walk-in patients?
- Are the hospitals or other facilities convenient and easily accessible?
- Do you have the option of going to an outpatient facility for certain tests or treatments?
Just because plans offered by different insurance companies provide standard benefits, do not assume that they cost the same. Compare all the costs, including deductibles, co-payments and the benefits provided.
Use the above work sheet and the Comparing Health Insurance Coverage work sheet to compare health insurance plans and to identify your out-of-pocket costs for the plan you are considering.
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