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Health
Insurance
2260 Gulf to
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727-669-8407
Managed Care.
More than half of all Americans have
some kind of managed-care plan. Various plans work differently and can include:
health maintenance organizations (HM0s), preferred provider organizations (PPOs)
and point-of-service (POS) plans. These plans provide comprehensive health
services to their members and offer financial incentives to patients who use the
providers in the plan.
How do I pick a health plan?
If your employer gives you a choice of plans or you need to
purchase your own coverage, it is crucial that you understand your health
insurance choices and pick the insurance that is best for you and your family.
Here are some questions you should ask yourself when choosing a
health insurance plan:
How affordable is the cost of
care?
What is the monthly premium I will have to pay?
Should I try to
insure most of my medical expenses or just the large ones?
What deductibles
will I have to pay out-of-pocket before insurance starts to reimburse
me?
After I've met my deductible, what percentage of my medical
expenses are reimbursed?
How much less am I reimbursed if I use
doctors outside the insurance company's network?
Does the insurance
plan cover the services I am likely to use?
Are the doctors, hospitals, laboratories
and other medical providers that I use in the insurance company's
network?
If I want to use a doctor outside the network, will the plan
permit it?
How easily can I change primary-care physicians if I want
to?
Do
I need to get permission before I see a medical specialist?
What are the
procedures for getting care and being reimbursed in an emergency situation, both
at home or out of town?
If I have a preexisting medical condition,
will the plan cover it?
If I have a chronic condition such as
asthma, cancer, AIDS or alcoholism, how will the plan treat it?
Are the
prescription medicines that I use covered by the plan?
Does the plan
reimburse alternative medical therapies such as acupuncture or chiropractic
treatment?
Does the plan cover the costs of delivering a baby?
What is the quality
of the insurance plan I'm looking at?
How have independent government and
non-government organizations rated the plan? For example, the National Committee
for Quality Assurance (http://www.ncqa.org) issues a Consumer Assessment of
Health Plans (CAHPS) report for every medical plan and facility.
What kind of
accreditation has the plan received from groups such as NCQA or the Joint
Commission on Accreditation of Healthcare Organizations
(JCAHO)
http://www.jcaho.org)
How many patient complaints were filed
against the plan last year and how many were upheld by state regulatory agencies
like the state insurance commission or the state medical licensing board?
How many members drop out of the plan each year? State insurance
departments keep track of "disenrollment rates."
Do the doctors,
pharmacies and other services in the plans offer convenient times and locations?
Does the plan pay for preventive health care such as diet and
exercise advice, immunizations and health screenings?
What do my friends
and colleagues say about their experiences with the plan?
What does my doctor
say about his or her experience with the plan?
What kinds of health insurance are there?
There are
essentially two kinds of heath insurance -- Fee-for-Service and Managed Care.
Although these plans differ, they both cover an array of medical, surgical and
hospital expenses. Most cover prescription drugs and some also offer dental
coverage.
Fee-for-Service.
These plans generally assume that
the medical professional will be paid a fee for each service provided to the
patient. Patients are seen by a doctor of their choice and the claim is filed by
either the medical provider or the patient.
