Doctors, Clinics, Hospitals
Consider how important it is to you to have a plan that allows you to receive care from the doctors, hospitals, and clinics you choose. Health Maintenance Organizations (HMOs) usually require you to select a primary care physician from the plan network to oversee all of your health care. Both HMOs and Preferred Provider Organizations (PPOs) encourage you to access a specific network of doctors and hospitals by charging lower fees for this network. Some plans may not pay for out-of-network services at all. To help narrow your choices, ask a trusted doctor which insurance plans she or he accepts.
If you or your family especially needs help with the cost of prescription drugs, check that your medications are included in the plan's list of covered medications (also known as a "formulary"). Sometimes a plan will cover the generic (non-brand name) version of the drug or a similar drug instead. You may wish to ask your doctor if these subsitutions would be acceptable for you.
Costs and Coverage
Consider whether you need coverage for frequent doctor visits or will use the plan only in the event of a hospitalization for a major illness.
Check if the plan has a maximum coverage dollar amount. Plans may have yearly or lifetime maximum benefit amounts, or may limit the amount of coverage for each hospital stay. Make sure the plan would provide enough coverage if you or a family member became seriously ill or injured.
Look carefully at what insurance companies exclude from their basic coverage by reading the member handbook and checking both what is covered and what is not covered. Do not base your decision only on advertisements, brochures, or conversations with insurance representatives - make sure you read the handbook.
Some insurance companies sell separate "riders," at an additional cost, to add more coverage to their basic policies.
You may also be interested in a plan that offers wellness benefits such as diet counseling or discounts for health club memberships. Consider how likely you are to use these benefits and if so, how much extra you are willing to pay for coverage that includes them.