1. If you get health insurance through work, find out what health plan choices are offered. Get information from the employee benefits office and/or from the insurance companies. Find out the time of year when you can join or change health plans. Even if an employer gives only one health plan choice, find out what the health plan provides. Find out what you need to do to get the health care that you and family members need.

  2. If you do not get health insurance through work, find out about health insurance from:

  3. -An insurance broker. This person can assess your needs and recommend a health plan to purchase on your own.

  4. -Professional organizations and social or civic groups that offer health plans to members.

  5. -Your state’s Health Department, Department of Community Health, or State Medicaid Office (for some low-income and disabled people).

  6. Find out if you are eligible for Medicare. Contact 800.MEDICARE (633.4227), your local Social Security Administration, or access www.medicare.gov on the Internet.

Wise Health Care Choices  »  Medical Care

Different Types of Health Plans

  1. Health Savings Account (HSA). Money set aside by you or your employer (on a tax-free basis) to pay for current and future medical expenses.

  2. High-deductible Health Plan. A plan that gives comprehensive coverage for high cost medical events. It includes a high-deductible and a limit on annual out-of-pocket costs. A health savings account or health spending account is usually coupled with this type of plan.

  3. Indemnity Plan. This type of health plan is also called fee-for-service. You can use any medical provider. The provider bills for each service given. You and the insurance plan each pay part of the bill as stated by the plan.

  4. Managed Care Plans. These kinds of plans provide services and handle payment for them. You have less paperwork with these plans compared to an indemnity plan. Managed care plans use certain doctors, hospitals, and health care providers. There are three basic types of managed care plans.

  5. -Health Maintenance Organization (HMO). With this, you pick a primary doctor who manages all of the medical services you receive. HMOs offer a range of health benefits. This includes preventive care.

  6. -Preferred Provider Organization (PPO). With this, a network of providers gives medical services at a discount to its members. With a PPO, you can choose one or more providers from a list of those who participate with the health plan.

  7. -Point-of-Service (POS). With this, you have the option to go to providers outside of the plan’s network of providers. Some of the cost is still paid for by the plan.

Plans vary; so do costs and what is covered. With any plan, a basic premium is paid by you and/or your or your parent’s employer. After that, you pay extra costs (deductibles, co-pays, etc.). These costs vary. They depend on the plan. Compare costs and how each plan handles services. These include:

  1. Routine checkups, health screenings, and vaccines.

  2. Preventive services, such as programs for weight control.

  3. Maternity care. Care by specialists.

  4. Hospital care. Emergency and urgent care.

  5. Mental health care.

  6. Substance abuse services.

  7. Physical therapy and home health care.

  8. Alternative health care.

  9. Prescription drugs. Find out what the plan covers.

  10. -Check out the plan’s formulary. This is a list of preferred generic and brand name drugs that the plan covers. In general, you have higher co-pays for brand name drugs than generic drugs. You pay even more for drugs not on the preferred list. Show your doctor your plan’s formulary when he or she prescribes medications for you.

  11. -Find out what mail order pharmacy and local pharmacies the plan uses.

More and more health plans are doing health risk assessments for their enrollees. People who have a higher risk for health problems may need to pay more. Find out if your plan has such a program. Reasons to pay more include being overweight, smoking, and having diabetes or high blood pressure.

Compare what different plans cover. Decide what is important to you and your family. Choose the plan that best meets your needs. Look at the quality of care, too.

Choosing a Health Plan

Agency for Healthcare Research and Quality