There are a bunch of reasons why you should not think you can choose a health plan “that’s right” for you. If you have Medicare, you can budget for your care with traditional Medicare, though you will need supplemental coverage to protect yourself from financial risk. And, if you are not yet eligible for Medicare, you can do some homework to keep your health plan costs down.
- Choice of doctors and hospitals: Each health plan has different networks of doctors and hospitals. Many people choose plans with narrow networks, which tend to have lower premiums. Ask your doctors about which health plan’s network they are in and then call the health plan to confirm. (Sometimes, the same insurance company will offer different plans, with different doctors in their networks.) Also, find out if the hospital you want to use is in the network.
- Costs: Before enrolling, understand all of your costs. On top of your monthly premium, some health plans charge a deductible, the amount you must pay before the plan begins covering your care. And, you will likely have a copay, a fixed amount you pay every time you see an in-network doctor, or coinsurance, a percentage of the cost you must pay. If you see out-of-network providers, you’re likely to be stuck with huge doctor and hospital bills. Most health plans will pay only a tiny portion of those bills, and many won’t pay anything.
- Access: Before receiving services, make sure you understand the health plan’s rules. Even if you use in-network doctors and hospitals, the health plan might require you to get a referral from your primary care doctor or prior authorization from the plan before it will cover your care. If the plan denies your care, be aware that you have appeal rights.
- Coverage: Each health plan has different rules about what it covers and under what conditions. Different health plans may offer different benefits. If you travel or live in another area during parts of the year, make sure your plan covers your care while you are away and what it will pay.
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