Do you know what critical information to check for when joining a health network? It can be overwhelming when trying to take in a lot of information at once that will undoubtedly affect your family’s access to quality health care providers when you need those services the most.
Deductibles, Premiums and Policy Accessibility
If you are healthy, you might not consider a health network important until you need medical services. It is critical that you take the time to research deductibles, premiums and accessibility to see if the expense is worth the value of the services you will receive. When you invest in a cheaper plan, it limits your access to many providers. If you anticipate starting a family or have a history of the family disease, you should research websites to see if a policy will cover services like Cigna drug rehab.
Will a Health Care Provider Cover Chronic Illnesses?
With the Affordable Care Act, changes were made to how insurance companies look at chronic illnesses. It also affects how patients value an insurance company that has a wider scope of in-network providers. They also prefer lower deductibles since they know they will possibly incur many bills within a yearly cycle. While a person with a chronic disease will expect a higher insurance rate, it is also feasible to choose a plan with a lower deductible and co-pay requirements.
Specialty Services Like Flu Shots or Holistic Services
Health care plans must offer minimal coverage that provides preventive care like birth control and yearly checkups. What about services like flu shots, holistic, or alternative health services? If you have a spouse or family, these are the type of “what if” things you need to anticipate so that you choose a medical plan that best fits your future family dynamics. You should also check prescription allowances. If not, you may well incur hundreds and even thousands a year in out-of-pocket prescription fees.
The Differences between HMO, PPO, POS or EPO?
There are four types of health plan networks: health maintenance organization (HMO), preferred provider organization (PPO), exclusive provider organization (EPO) and point-of-service (POS) plan. HMOs are restrictive in that you only receive coverage if you choose an in-network provider. PPOs are preferred provider organizations that give discounts for in-network but also provide out-of-network coverage even though discounts and rates are not guaranteed. You may also incur out-of-pocket fees as your insurer only pays fair rates. POS plans require patients to identify a primary care provider. An EPO plan is similar in that it is an exclusive provider organization that sets the rules for care.
Co-pays and Financial Responsibilities
A co-pay is a set fee that you must pay when you receive medical care. It may differ greatly based on the type of care you receive. Your deductibles may also differ based on regular or specialty care. It is critical that you research or read a summary of benefits and coverage to understand the co-pay costs and other financial responsibilities.
Never wait until you need medical care to understand your health care plan as it will mean the difference between mediocre out-of-pocket expenses and quality care available in-network.