Living with Chronic Pain

Is Your Health Plan Right for You?


Picking a health plan is one of the most important things you can do to ensure proper treatment. Here are four tips for picking the right one

1. Find out where you can go for treatment

Every insurance plan allows you to seek treatment from a particular team of health care providers. This includes what hospital and pharmacy you can go to in your in-network services. Seeking treatment from someone who is not in your network will cost you extra money. PPOs, or preferred provider organizations, provide some coverage for out of care networks, but most of the time the patient will still have to pay a high rate. To determine what rate you will have to pay, check to make sure your preferred hospital, pharmacy or physician is included in your health care plan.

2. Determine what your premium and deductible are

Most health plans include a premium and a deductable. A premium is the monthly rate you pay for health insurance while a deductable is what you pay out of pocket before insurance kicks in. In other words, if you have a $500 deductible, your insurance will not cover any services until you have paid for this amount first. Check with your health care plan’s deductible and premium rates. Also be sure to determine what services your deductible covers.

3. Find out if medications are covered

When reviewing a health care plan, it is especially important to determine if medications are covered. There are three things you need to be aware of. Formulary refers to a list of medications that a healthcare plan will cover. Make sure your medications are covered by checking them against the plan’s formulary. Step therapy may require you to “fail first”. In other words, a medication will only covered if the health care plan’s first choice did not work. Finally, prior authorization requires your doctor to obtain approval for any medication that is not on your plan’s preferred list.

4. What is the plan’s out-of-pocket cost?

Always be sure to know what your plan requires you to pay for aside from the premium and deductible rates. Some may require co-pays, which is a fixed amount or a flat fee to cover certain medications. Also be sure to ask about additional out-of-pocket costs when choosing a plan.

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