Employer Health Insurance
If your employer offers health insurance, you may be able to choose among several health insurance plans. Most often, these plans include some type of managed care plan, such as a health maintenance organization (HMO) or a preferred provider organization (PPO). If you choose an HMO, the plan will only pay for care if you use a doctor or hospital in that plan's network. If you choose a PPO, the plan will usually pay more if you get your health care within the plan's network. The PPO will still pay a portion of your care if you go outside the network, but you will have to pay more.Your employer may offer a number of different health plans that cost more or less depending on the services offered and the amount of out-of-pocket costs you have each year. These costs may include a copayment each time you see your doctor or get a prescription filled as well as a yearly deductable, which is the amount you pay for healthcare services at the beginning of each year before your health insurance kicks in.
Your employer also may require that you pay more of the premium for health plans that are more expensive. In general, a plan that requires that you use a network provider, has a high deductable, and high copayments will have lower premiums. A plan that allows you to use any provider, has lower deductibles, and lower copayments will have higher premiums.
If you are young, have no chronic disease, and lead a healthy lifestyle, you may consider choosing a health plan that has high deductibles and copayments-you are unlikely to need care and your monthly premiums may be less.
If you are older and have a chronic condition (such as diabetes) that requires frequent doctor visits and prescription medications, you may consider a health plan with low deductibles and copayments. You may pay more each month for your share of the premium, but this may be offset by less out-of-pocket costs throughout the year.
To learn more about your health plan options, meet with a representative of your human resources department or read the materials supplied by the health plan. You also can go online to get more information about each health plan. If both you and your spouse/partner work for companies that provide health insurance, you should compare what each company offers and choose a plan from either company that meets your needs.
If you are self-employed, your employer does not provide adequate health insurance, or you are uninsured and do not qualify for a government health insurance program, you can buy health insurance on your own.
You can buy health insurance directly from a health insurance company, such as Blue Cross, through an insurance agent who represents an insurance company, or online from reliable companies. Consult with your insurance agent who may be able to help you find health insurance that fits your needs.
Since cost is often the most important factor when choosing a health plan, your answers to the following questions can help you decide which plan to purchase.
- How much is the monthly premium?
- How much will I have to pay before the health plan kicks in?
- How much is the copay for doctor's visits and prescription medications?
- If I choose a PPO, how much will I have to pay if I use doctors or hospitals outside of the PPO's network?
- Is there any limit on how much the health plan will pay for my care in a year - am I protected from large medical costs?
- What health services are not covered?
- If I have a medical condition (such as diabetes) will the health plan provide coverage immediately or do I have to wait six months or more?
- Does the health plan have a drug formulary that includes the medications I use?
- Is my doctor in the health plan's provider network?
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