Health Insurance Buyers Guide

How to Compare & Buy Health Coverage
Brian J Schroeder
2009-05-19

Shopping for health insurance coverage can be very confusing. We help many people each day select the best health plans for their unique health care needs and budgets. When comparing health plans, it's important to compare plan benefits, as well as, plan premiums. We perform a simple cost/benefit analysis to sort through the confusion and arrive at the best solution.

Step One - decide what kinds of health benefits you really need and want. Most people tend to buy too much coverage. Recall how many times in the past 2 or 3 years that you have seen your doctor, had a preventive check-up, filled some prescriptions, or visited the emergency room. Make a list of what you need in a plan. You may need only a basic PPO plan with limited office visits and generic only prescriptions, or you may require a plan with more comprehensive coverage. If you plan on having children, be aware that most PPO plans today do not offer maternity coverage. If you have a preferred doctor, preferred hospital, or favorite dentist, ask them which provider networks they are contracted with and compare only plans from carriers that give you access to those networks.

Step Two - determine how much you can actually afford to pay per month to keep your plan in place. If you let your coverage lapse, it will not be in place when you may really need it. This would be a financial hardship and a total waste of your money. Remember, you're buying a policy mainly to cover the costs of a devastating accident or illness, not for a cold.

Step Three - look for the health insurance plans that will give you the most benefits at a price you can afford. Estimate what your out-of-pocket costs would be for services you will definitely use and also for services not covered that you anticipate needing. The deductible will influence the monthly premium. The higher the annual deductible, the lower the monthly premiums. Look at the coinsurance percentages and annual maximums. Add them together to see what your total annual out-of-pocket cost would most likely be for each plan.

Remember, buying a health plan without the coverage and benefits you actually need will not be a bargain at any price.

The following questions can help you compare both the benefits and the costs of the plans you are considering:

  • What portion of my doctor and hospital bills (coinsurance) will this health insurance plan pay for?
  • How much must I pay each month (premium) for this plan? Can I comfortably afford it?
  • How much would I need to pay (deductible) before the plan begins to pay for major medical services? Can I afford it?
  • How much will I pay for office visits (co-pays) to the doctor? How many per year at that price?
  • Does this plan pay for any preventive health care? How much? This includes routine medical checkups, cervical screenings, PAP tests, PSA tests, mammograms, and shots to prevent disease.
  • Does this plan have rules for people who already have serious, chronic medical problems (pre-existing conditions)? Will these rules keep me from getting the care I need? If so, for how long?
  • What services are covered by this health insurance? Will it pay for a hospital emergency room visit or urgent care center? Besides routine surgery, hospital stays, doctor visits, and prescriptions, does the plan cover skilled nursing facility stays, home health care, and durable medical equipment and medical supplies?
  • Does this plan cover visits to the eye doctor and the dentist?
  • Does this plan cover prescription drugs, generic only or including branded drugs?
  • Does this plan limit my medical costs (annual out-of-pocket maximum) in case of a catastrophic illness or injury? Would my costs be so high that I could not afford to pay for them? Is there a limit to how much I would pay each year?
  • Is there a yearly or lifetime limit (lifetime maximum) to how much the plan will pay for medical costs?

Talking with an experienced health insurance agent may be the best way for you to get the health coverage you really need at a price that is comfortably affordable.

For now, if you have other questions please don't hesistate to call us at (510) 352-7525.

AdvoCare Insurance Services

2450 Washington Ave., Suite 190
San Leandro, CA 94577

Phone

(510) 352-7522

Fax

(510) 352-7525

Insurance Brokers

Brian J. Schroeder - LUTCF
Imre von Komarnicki - CLU