Career, Tips

How Good is Your Health Care Plan?


Nothing is more important than our health, which is why we each try our best to take care of our bodies and our minds. But nothing is guaranteed when it comes to our health, which is why we invest in health insurance. Health insurance is there to protect us if our health care costs suddenly skyrocket. But health insurance isn’t just for emergencies – or, at least, it shouldn’t be. Good health care plans can keep us from spending too much on regular doctor’s visits, prescription medications, and much more.

Of course, how much your health care plan helps you depends on how good your health insurance is. Our insurance companies and our government are already tracking how effective our insurance plans are by using metrics like HEDIS (the Healthcare Effectiveness Data and Information Set). Shouldn’t we check on our own plans ourselves, too?

How health insurance works

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Health insurance is insurance, of course, so the idea is that we each pay monthly premiums and the money is pooled to be dished out, in the case of emergency, to those who need it. The insurance companies stay in business by making more in premiums than they deal out in claims, and we benefit by being protected in the case of an emergency.

Like some other types of insurance, health insurance is designed to encourage us to reduce our own risks, and so claims are pretty routine. Your health insurance provider wants you to go to the doctor, so they my cover regular check-ups, and expect to pay for that regularly. The idea is to avoid a larger claim later on.

In general, you’re always paying the insurance company somehow. If you pay a high monthly premium, your insurance will cover more – and your deductible, which means the amount you’ll have to pay before the insurance kicks in, and copays, which are amounts you pay when sharing costs with your insurance, will go down. Lower deductibles and copays mean higher premiums. Insurance policies usually also have a maximum out-of-pocket cost, after which you won’t be responsible for most expenses.

What to look for in your health insurance

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So right away we have a few basic things to look at in health insurance: premiums, deductibles, copays, and maximum out-of-pocket costs. But we also want to look at how your insurance covers various things. A low deductible and low maximum out-of-pocket costs are good things to have if disaster strikes, but if your share of the copayment on prescriptions is relatively high, then your regular annual care needs may end up being rather pricey. Check your health insurance policy on the following things:

  • Emergency care. This is the big reason you have health insurance! If you suffer a serious injury or sudden illness, what’s the most you could pay? You have insurance because you don’t want to go bankrupt over health care, so make sure that your policy protects you financially.
  • Regular check-ups. These should be covered. Check to see if there’s a copay or a limit on covered visits per year.
  • Specialists. Are they covered? Do you need a referral? Do they have locations near you?
  • Mental health. Good insurance policies should cover psychiatrists and psychologists. What are the copays?
  • Substance abuse. You may not think you need to go to rehab, but facilities like Beachside Rehab should be covered by your insurance.
  • Prescriptions. Prescription drugs aren’t cheap, so make sure you have coverage! Watch out for copays that only kick in after you reach your deductible. If you’re not taking prescriptions regularly, you may never reach the deductible, meaning you’re just paying full price for medicine.
  • Eye care. Do you need glasses or contact lenses? You may need separate insurance. Make sure that you’re covered for eye exams and glasses – some insurance companies cover “eye care” but only mean eye trauma.

In each of these cases, you’ll want to evaluate the copays and deductibles that apply. Insurance is always a bit of gamble, but try to get as much covered as you can – even if you don’t think you’ll need it. A good health insurance policy may cost you money if you stay healthy, but it’s essential if you fall ill.

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