The medical and legal jargon of Health Insurance suits only those who make a living selling Plans: it confuses most customers and leaves them wondering if they and their children will have adequate coverage during the coming year! Most of us wait until nearly the end of annual open enrollment to make hurried and sometimes ill-advised decisions on the vital matter of Health Insurance.
An easy approach to a complex matter
Here is a simple 5-step approach to making the right decision for Health Insurance to protect yourself and your loved ones:
1. Start by selecting a Primary Care Physician who can manage all your Health concerns. A family doctor of long standing could be a good choice, but ask around for a professional of good standing if you have just moved to a new neighborhood. It helps if the doctor responsible for your health and that of your family has a wide network of specialists, and a member of an HMO or Health Maintenance Organization. You would have to pay a higher premium if you choose a Primary Care Physician in a PPO or Preferred Provider Organization. Do look for a doctor who has the time and who is willing to make an effort to let you participate in treatment decisions. A busy and rude doctor who writes prescriptions with little time and patience to explain matters to you, could leave you worried and humiliated after a consultation.
2. Make a thorough assessment of each member of your family who has to be covered by a Health Insurance Plan. Think through if you plan to marry or to expand your family during the coming year. You do not want the joys of a pregnancy to be marred by medical expenses that a plan that does not cover. Consider you family history and prepare for the worst, though no one wishes you ill: Type II diabetes, hypertension and certain gynecological cancers have habits of preying on certain families. These conditions are all expensive to manage. Your chosen plan should provide for full coverage if an inherited condition were to stop by at your home. You should be financially prepared for medical consequences of bad eating habits, taking nicotine or drugs in any form, drinking too much and inadequate exercise. The doctor who has looked after you during the past year would be best suited to serve as devil’s advocate and list some illnesses to which you may be vulnerable.
3. Take stock of your finances and choose a plan that suits your liquidity. You may be fortunate to write monthly or quarterly checks to cover every medical condition that is even remotely possible. However you can cut corners with reasonable safety if you opt to exclude certain conditions. Such risk taking should go hand-in-hand with a concerted attempt to improve your state of health. You could for example decide to forego cover for some expensive surgery and hospitalization just by scientific dieting, changing risky habits such as smoking and making it a point to work out thrice a week. A different but effective route to economy is to opt for larger co-payments in return for a smaller premium. This means you pay less as a matter of course, but share more of the bill for each visit to the doctor or pharmacy.
4. Now find an authorized agent of a Health Insurance company that is a member of AHIP or America’s Health Insurance Plans. The agent should reside within easy reach and come with reliable references of having helped some of your trusted friends in their times of need. This does not matter if you have legal training or an accomplished attorney who will serve you for free, but the fine print of a plan can be tough for lay people to decipher! Portability may prove bothersome when you change your job, and the process of appeal against rejected claims can be rather frustrating. Most people need a helping hand to guide them through deliberate exclusion of certain indemnity. This is integral to getting affordable Health Insurance, without taking undue risk with respect to likely and expensive medical conditions.
5. The fifth and last step follows from the first four. Do not wait until the end of the enrollment period to choose your plan. The truism "haste makes waste" certainly applies to Health Insurance, and providing optimal protection needs that you have plenty of time on hand. It is easy to get a quote for just any plan, but comparison of alternatives needs focused attention and repeated reviews. Injudicious exclusions can result in hopeful savings becoming intolerable burdens of cost. It is hard to overdo the imperative of careful and repeated consideration of each medical condition, form of treatment, procedure and medication that a plan does not cover in large part if not fully.
Have a healthy year ahead, and relax in the knowledge that you and the ones who count on you are adequately protected from financially inability to get state-of-the-art health care.