The definition of "good" varies from person to person and business to business. However, here are some of the aspects of a health insurance policy I advise my clients to be aware of and comfortable with:
1) Are the doctors, hospitals and pharmacies you want to use in-network providers with the health insurance plan you are considering?
2) What would your coverage be (if any) if you want to use a health care provider who is not an in-network provider with the health insurance plan you are considering?
3) What is the pharmacy benefit under the health plan you are considering? And, if you have specific prescription drug needs are they covered under the health insurance plan's prescription formulary and to what extent are they covered (copays, co-insurance, deductible & co-insurance)?
4) Does the health insurance plan allow its members to go directly to specialists such as cardiologists or does it require that you are referred to a specialist by your primary care physician first?
5) If you travel regularly outside of your home area (to other states or outside the USA) does the health plan provide for coverage outside of your home service area in the event you need non-emergency care?
6) Is the health insurance company you are considering a well established national or regional health insurance carrier with strong finances or is it one of the new, experimental Co-Op health plans recently established under the provisions of ObamaCare?
7) Does the overall value proposition of the health insurance plan you are considering meet your current and anticipated needs? In other words, does its monthly premium, coverage levels and provider network really work for you.
The 1st post was made in 2014... SO MUCH HAS CHANGED... in my state I start with 2 questions. #1) What will you make this year - So I can assess if the person is, or is not, eligible for subsidies. If NOT, we don't mess with Healthcare.gov (or the state site if there is one). Question #2) WHO do you want to see when you need service?
WHO IS MORE important than the rate you pay. In my state we had ALL PPO's before this year. Now there are also carrier options with an EPO & POS. No HMO's in my state as of now. Yet the HMO model is prevalent in many states.
Who
When
Pre-authorization
Gate Keepers
Out of Network
Traveling
& many other factors make up WHO... The network type & size IS YOUR HEALTH INSURANCE.
Don't settle for a tiny network that has no out of network coverage.
Go PPO if you can....
Regional Marketing Director, Capital Choice Financial Group,
The question should be "is there a good insurance plan left?" With the passing and implementation of Obamacare the companies writing health insurance dwindled down to only two companies and thus the choices diminished too. A good plan should have a deductible of not more than $5000 and doctor visits if you feel comfortable. Out of pocket costs should be reasonable too, around the same amount as the deductible. Dr. visits are ok if you are one that would use them. But, because of the cost of Obamacare the deductibles have skyrocketed and the out of pocket costs the same. A really good plan for most Americans today is a thing of the past.
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1) Are the doctors, hospitals and pharmacies you want to use in-network providers with the health insurance plan you are considering?
2) What would your coverage be (if any) if you want to use a health care provider who is not an in-network provider with the health insurance plan you are considering?
3) What is the pharmacy benefit under the health plan you are considering? And, if you have specific prescription drug needs are they covered under the health insurance plan's prescription formulary and to what extent are they covered (copays, co-insurance, deductible & co-insurance)?
4) Does the health insurance plan allow its members to go directly to specialists such as cardiologists or does it require that you are referred to a specialist by your primary care physician first?
5) If you travel regularly outside of your home area (to other states or outside the USA) does the health plan provide for coverage outside of your home service area in the event you need non-emergency care?
6) Is the health insurance company you are considering a well established national or regional health insurance carrier with strong finances or is it one of the new, experimental Co-Op health plans recently established under the provisions of ObamaCare?
7) Does the overall value proposition of the health insurance plan you are considering meet your current and anticipated needs? In other words, does its monthly premium, coverage levels and provider network really work for you.
WHO IS MORE important than the rate you pay. In my state we had ALL PPO's before this year. Now there are also carrier options with an EPO & POS. No HMO's in my state as of now. Yet the HMO model is prevalent in many states.
Who
When
Pre-authorization
Gate Keepers
Out of Network
Traveling
& many other factors make up WHO... The network type & size IS YOUR HEALTH INSURANCE.
Don't settle for a tiny network that has no out of network coverage.
Go PPO if you can....