Living with Chronic Pain

Tips for Choosing the Best Health Care Plan in the United States

Source: WebMD

Choosing an insurance plan that covers an individual’s health care needs while also considering their financial status can be complicated.

Three things to consider when choosing a health insurance plan include the following:

Covered providers

Every insurance plan provides in-network health care providers, hospitals and pharmacies. Some plans may only pay a small percentage of medical expenses if a provider is out-of-network. To determine what hospitals, pharmacies and physicians are covered under the policy, contact the insurance company.

Premiums, copayments and deductibles

Most health plans include premiums, copayments (copays) and deductibles. A premium is the monthly rate the insured pays for health insurance, a copay is a set amount paid by the insured for health care visits and medications, and a deductible is the money paid out-of-pocket before insurance begins to cover costs. For instance, if the deductible is $500, the insurance company will not cover any services until the insured has paid for this amount. The dollar amount of premiums, copays and deductibles vary among different health insurance companies and plans. Also, be sure to ask about any additional out-of-pocket costs when choosing a plan.

Medication coverage

When reviewing a health care plan, it is especially important to determine if medications are covered. Prescription medications are a major cost for many people. Ensure that the insurance company will pay for required medications. A pharmacist can help determine what medications are covered under a specific insurance policy. Many insurance companies use “drug tiers” to determine what a specific medication will cost. Some plans require that the prescribing physician obtain prior authorization for medications that are not on their preferred list.

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