Continuing last week’s discussion, Choosing the Right Health Plan, let’s look at how the actual Benefit Design can — and should — shape your purchasing decision.
When we say benefit design, we’re simply acknowledging that medical insurance plans come in various shapes and sizes; you need to pick one that fits you and your family.
What’s in a Name?
Everything. The name itself often represents the type of product, reflects plan rules or highlights a unique element. Example: HDHP stands for “high deductible health plan!”
HMO, PCP, Gatekeeper — these names are associated with benefit designs from health plans versus insurance companies. They generally require a referral from a primary care physician before you see a specialist. Does that work for you? Are you willing to engage with a primary care physician as part of your health care team? Open Access, on the other hand, typically means you don’t need a referral from a primary care physician to see a specialist.
Points of Service
Before purchasing a health plan, make sure you understand how it’s designed in terms of service. For instance, will you be covered — to some degree, at least — if you see a non-participating doctor?
Warning: if you call a doctor’s office to see if they participate with your insurance and you get this response, “We accept all insurance” DO NOT think it means they participate with your plan. It simply means they’re willing to accept a check from anyone. Ask more questions.
Need physical therapy? Want to see a chiropractor? Make sure these services are covered and if there are limits on visits. It’s not unusual to see benefit designs with limited coverage for these services.
There’s a lot to consider when choosing a heath plan. And the wrong decision can be costly. Check with your state’s Department of Insurance website for a list of all licensed insurance companies and health plans doing business in your state. See what’s available. And when in doubt, consult an expert for advice.