If you're thinking of buying health coverage or switching plans and want to compare their features, here are some questions to ask: Traditional Health Insurance How much does it cost? Are there any cost options or possible extras -- prescription drug coverage, eye care, dental care or others -- I may want to buy? What's covered? At the doctor's office? At the hospital? At the dentist, if included? What's not covered? Are there lifetime dollar limits on some kinds of coverage, or on all payments? How much? Who else in my family is covered? Until what age are my children covered? Are there deductibles or copayments for some services and how much? Many plans, for example, make you pay the first $25 or $100 or even $500 a year (the larger the deductible, typically, the less expensive the plan). Many then pay, say, 80 percent of some further charges after the deductible, and you pay the rest. Are there waiting periods for some kinds of coverage, say, maternity care? Can I go to any doctor or hospital, or must I only go to those approved by the insurer? Does the plan cover my entire hospital bill (except for personal items like TV and phone) or the main share of it? If you find a plan that covers only "room and board," beware -- that's only a fraction of today's entire daily hospital bill. Does the plan include "major medical" (sometimes called "catastrophic" or "stop-loss") coverage? This is a must today. A typical major medical plan may make you pay 80 per cent, say, of most charges up to $2,500 or so a year, then pay everything further. Can my policy be canceled for any reason? Can I renew it as often as I like? What happens after I reach 65? What if I leave my employer or group? Can I buy favorable individual coverage? What if my spouse has our only coverage and I'm divorced? Conversion to an individual policy should be possible. HMO or IPA
You might ask these as well as many of the preceding questions: Who will my doctor be? Can I pick my own doctor? And count on regularly seeing that doctor when needed? What are the doctor's qualifications? Is he or she board-certified (by a family practice or internal medicine or other specialty board)? There are excellent non-certified doctors, but the better HMOs have a high percentage of board-certified practitioners. Will I sometimes be seen by a nurse-practitioner or physician's assistant instead of a doctor? If I'm dissatisfied, may I then see a doctor? Can I change doctors if I want? What specialties does the plan include? Does it have specialists in eye care, dermatology, obstetrics and gynecology, pediatrics, mental health -- or whatever areas concern me? What if I want to see a specialist? Must I have my doctor's approval? The answer is often yes. What if I go to a specialist or other doctor outside the plan -- will the plan pay? The answer is usually no. Where do I go for care? Is it convenient? What are the hours? How long does it generally take to get an appointment? (One authority said an ideal might be no more than a week for non-emergencies, two weeks to see a specialist. I've often waited much longer than that to see non-HMO doctors.) What if I have an emergency or an urgent need to see a doctor right away? What about nights, weekends, holidays? Where do I go if I have to be hospitalized? Do I have any choice? What if I have a complaint? Is there a grievance procedure? Is there a specified ombudsman or patient representative to hear me? Is there any arrangment for appeal or review of any differences over my treatment or coverage?
If the answer to all these questions sounds great, let me know. I may switch, too.