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How do I Choose the Best Health Insurance Provider?

Article Details
  • Written By: Malcolm Tatum
  • Edited By: Bronwyn Harris
  • Last Modified Date: 16 April 2018
  • Copyright Protected:
    2003-2018
    Conjecture Corporation
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Whether choosing a group insurance carrier to provide health insurance for a company, or purchasing individual health insurance coverage, the task of selecting the right health insurance provider can be intimidating. With so many possibilities, it may seem overwhelming to wade through all the options and settle on the coverage that will be both affordable and beneficial to everyone concerned. Fortunately, keeping a few basic factors in mind as you evaluate different providers will make the task much easier to accomplish.

One of your first steps in preparing for the task is to make a list of what you need in terms of coverage. This includes having an idea of how much you can spend in the way of a monthly premium, any special needs that must be taken into consideration, and any pre-existing conditions that could impact the cost or scope of the health insurance. It is also a good idea to determine if you want to remain with your current primary care physician, or be willing to change doctors in order to take advantage of a good package offered by a given health insurance provider.

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With your basic needs and wants defined, you can begin to look into the different types of plans offered by different providers. There are three specific plans that may be offered by any given health insurance provider. The PPO, or Preferred Provider Organization, usually provides lower deductibles and other benefits if the insured party chooses to use health care professionals associated with the provider network. However, the plan still provides some coverage even if an out of network physician is utilized.

The HMO, or Health Maintenance Organization, generally offers a plan with lower or no deductibles, thus keeping out of pocket expenses for the insured party to a minimum. With an HMO, the health insurance provider creates a network of healthcare professionals, and requires that each insured party be assigned to a primary care physician who is within the network. In general, an HMO does not pay for medical services rendered by an out of network physician unless there are highly unusual circumstances, such as an emergency situation.

The POS, or Point of Service, option is an interesting hybrid of the HMO and the PPO. With this type of plan, the health insurance provider seeks to combine the best attributes of both plans into a workable health coverage package. For example, a POS may allow the insured party a great deal of latitude in choosing a primary care physician, but also provide preventive care measures such as a free annual physical exam as part of the coverage.

Once you have a firm understanding of they types of coverage available, take a good look at the costs. This includes not only the monthly premium, but also any deductibles that must be met for such line items as doctor visits, medication, and major medical coverage. Along with the deductibles, make sure you understand what types of co-payments are required, such as a fixed rate per doctor visit or the different co-pays for name brand or generic medications. Having an idea of the possible out of pocket expenses will help narrow the list of possible selections for your new health insurance provider.

One aspect that many people overlook when considering the offer of a given health insurance provider is the scope of the medical coverage itself. Make sure you know the rules on preexisting conditions. Some policies require a waiting period, such as nine months to a year. Others disallow preexisting conditions permanently. Also check for any common ailments that are excluded from coverage altogether, even if they are not pre-existing. If you find a number of common ailments that are not included in the coverage, that particular medical plan may not be for you.

Choosing the right medical coverage does take some careful screening and attention to detail. However, the efforts usually pay for themselves in terms of establishing a working relationship with a health insurance provider that meets all or most of your needs and does so at rates you can reasonably afford.

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