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Top 5 Things to Consider Before You Pick a Plan
Whether you are considering a health plan during your open enrollment period at work or choosing a plan for the first time under the Affordable Care Act, there are some important details to think through. Ultimately, the insurance plan you pick determines the doctors you can see and the hospitals you can use, and has the ability to directly influence the quality and cost of your care. Here are the top five things to consider when choosing the right health plan for you and your family:
1. Determine Your Healthcare Needs
Before you start comparing plans, think about what types of care you will need over the course of the next year. Are you and your family relatively healthy and visit the doctor for preventive care? Or do you or one of your family members have a chronic condition that requires regular follow-up appointments, prescription medication, or specialty care? Perhaps you and your family are healthy but you anticipate needing elective surgery.
2. Review Your Insurance Plan Options
If you are shopping for your own health insurance through the marketplace, you'll see four categories of options named after metals: bronze, silver, gold and platinum. Bronze plans will generally have the lowest monthly premiums but have higher deductibles, co-payments and co-insurance compared to platinum plans. Employer-based plans also differ by premium and out-of-pocket costs. Consider your family's healthcare needs and make sure you understand the total cost you are likely to pay for insurance.
3. Evaluate Doctor Expertise and Patient Satisfaction
Since your insurance plan determines the providers you can see, pick your doctor before your plan. Talk to your family and friends for recommendations, then research the doctors' experience and credentials, including whether they are board certified and have the expertise to treat your condition. Your goal is to find the best doctor who meets your needs and whom you can trust. You can find expertise, board certification, and patient satisfaction reviews on more than 3,000,000 providers at www.healthgrades.com. But just as important as your doctor choice is hospital choice—not all hospitals perform equally.
4. Evaluate Hospital Performance
You may not be thinking of hospitals as you pick an insurance plan, but this is just as important as your doctor choice. You need to make sure your doctor has admitting privileges at a hospital recognized for quality performance in areas that are relevant to your care needs. First, research hospitals in your area that perform better than expected (5-stars) for the care you need, then find a doctor who can admit and treat patients at this hospital. If a doctor’s hospital falls short in quality, you should find a doctor who treats patients at a hospital likely to offer you the best possible outcome.
5. Decide Which Plan Best Meets Your Needs
Don’t let cost be your only factor in choosing a plan. Considering both quality and cost will lead you to the right provider and plan for your particular needs. To take maximum advantage of your insurance benefits and to pay minimal out-of-pocket expenses, you need to choose a plan that your doctor and hospital participate in. Be realistic about all the healthcare needs you and your family may have during the year and select the plan that best meets your needs.
The Choice Is Yours
Americans are virtually unanimous (97%) in agreeing that having the right information is the key to making good healthcare decisions. Yet, they admit they are more likely to choose a hospital based on convenient location (58%) and amount of co-pay (45%) than on quality outcomes data (30%). These numbers come from a recent Harris Interactive Research survey of 1,000 consumers across the country, which reveals consumers currently use factors other than quality to make their choices. Many Americans may not realize the information they desire is at their fingertips. Using Healthgrades.com or the HG app can provide the needed information regarding quality performance and outcomes.