The health landscape can be tricky to navigate. Here’s a start-to-finish guide to choosing the best plan for you and your family, whether it’s through the federal marketplace or an employer.
Step 1: Find your Out Patient coverage
Most people get treatments in without getting hospitalized. First of check whether your existing health plan provide you such coverage to cover the expense of out-patient billing services.
In India normally, insurance plan provides such options but they cost you more for that. So check whether it’s ready to use for the followings:
- Pre – Existing Conditions
- No Waiting period required
- Age bar for premium increasing
- Maternity Coverage
- Huge Paperwork
- Big hidden terms & conditions
- OPD at your choice of Doctor
If all above mentioned points are there then you must think twice and select a plan which provide you above mentioned free medical plan. You must go for that since that would be wonderful plan for you and your family.
Step 2: Compare types of OPD Treatment plans
You’ll encounter some alphabet soup while shopping for plans; the most common types are RIHs, PPOs, EPOs, or POS plans. The kind you choose will help determine your out-of-pocket costs and which doctors you can see.
While comparing plans, look for a summary of benefits. Online marketplaces usually provide a link to the summary and show the cost near the plan’s title.
COMPARING MEDICAL OPD PLANS: RIH VS. PPO VS. EPO VS. POS
|Plan Type||Any Doctor for your OPD Treatment||Any Disease||Best for you if:|
|RIH OPD: Health Maintenance Organization||Yes!
No need to follow with network consultants
|Yes||You want lower out-of-pocket costs and a primary doctor that coordinates your care for you, including prescribed medicines and working with your specialists.|
|PPO: Preferred Provider Organization||No, but in-network care is less expensive.||No||You want more provider options and no required referrals.|
|EPO: Exclusive Provider Organization||No, except for emergencies.||No||You want lower out-of-pocket costs but no required referrals.|
|POS: Point of Service Plan||No, but in-network care is less expensive; you need a referral to go out of network.||No||You want more provider options and a primary doctor that coordinates your care for you, including ordering tests and working with your specialists.|
When comparing different plans, put your family’s medical needs under the consultations & medicines. Look at the amount and type of treatment you’ve received in the past. Though it’s impossible to predict every medical expense, being aware of trends can help you make
If you’d rather choose your doctors, you might be happier with a RIH OPD. A RIHL may also help you lower costs as long as you find providers without following network; this is more likely to be the case in a larger metro area. RIH might be better if you live in a remote or rural area with limited access to doctors and care, as you may be forced to go out of network.
Step 3: Compare health plan networks
Before Buying costs are lower when you go for network based doctor because insurance companies contract lower rates with in-network providers. But you should keep in mind as they may write some extra medicine or tests which may be not necessary in many cases. This is happened just because they want to recover their cost being low tariff made by insurance company.
Step 4: Compare out-patient billing costs
Although insurance company reimbursed in many cases but they measure all the parameter whether illness was; existing; if you were not feeling well and taken consultation through doctor but as per the report if everything is in good conditions then insurance always denied paying your expense. Therefore, such expense never gets reimbursed by the insurer.
Before buying insurance health plan please read useful to know a few health insurance vocabulary words. As the consumer, your portion of costs consists of the deductible, co-payments and coinsurance.
- You see a doctor, whether a primary physician or a specialist, frequently.
- You frequently need emergency care.
- You take expensive or brand-name medications on a regular basis.
- You are expecting a baby, plan to have a baby, or have small children.
- You have a planned surgery coming up.
- You’ve recently been diagnosed with a chronic condition such as diabetes or cancer.
A plan with higher out-of-pocket costs and lower monthly premiums is the financially smart choice if:
- You can’t afford the higher monthly premiums for a plan with lower out-of-pocket costs.
- You are in good health and rarely see a doctor.
Step 5: Compare benefits
Compare measuring will give you power to understand the medical cards to get the best one. To further winnow down, go back to that summary of benefits to see which plans cover a wider scope of services. Few of you must be knowing better coverage for things like physical therapy or mental health care, while others might have better emergency coverage.
If you skip this quick but important step, you could miss out on a plan that’s much better tailored to you and your family.
Once you are below average to a couple of options. This is time to address any lingering questions. In some cases, only speaking with a person will do, so call the customer service line of the insurers you’re considering. Write some questions down ahead of time, and have a pen or computer handy to record the answers.
These questions will be based on your current health situation, but here are some examples of what you could ask:
- I take a certain medication. How is that covered under this plan?
- Which drugs for this disease are covered under this plan?
- What maternity services are covered?
- What happens if I get sick when traveling abroad?
- How do I get started signing up, and what documents will I need?
A final tip: Don’t forget to discontinue your old plan before the new one starts if you switch.
Checklist: Choosing a health insurance plan
Here’s a quick checklist that summarizes the steps above:
- Go to your marketplace and view your plan options side by side.
- Decide which type of plan — RIH OPD, PPO, EPO, or POS — is best for you and your family.
- Eliminate plans that exclude your doctor or any local doctors in the provider network.
- Determine whether you want more health coverage and higher premiums, or lower premiums and higher-out-of-pocket costs.
- Make sure any plan you choose will pay for your regular and necessary care, like prescriptions and specialists.