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How to choose a health plan

Health plan home | Health-care models | Choosing a health plan | Choosing a doctor | Helpful hints


After you understand the basic health-care models, it is important for you to assess your needs before deciding on a plan. Consider three key factors when choosing your health-care plan: coverage, quality, and cost. For each of these factors you will need to research and compare. This means making phone calls, reading brochures, asking questions, and most importantly, evaluating the services you and your family are most likely to use.


Coverage will vary from plan to plan. Read over the information provided by the healthcare plan CAREFULLY. If anything is unclear or if you think that the plan does not match all your needs, call the company's customer service center and ask ALL your questions. This may take some time, but in the long run you will benefit from thorough exploration of your options.

The following list of questions will help you assess what type of coverage you need for you and your family:

  • Are you and your family basically healthy, requiring only routine checkups and minor medical attention?
  • Does anyone in your family have a chronic condition that requires regular attention and/or the care of a specialist?
  • Does anyone in your family have what would be considered a "pre-existing condition"? What does the plan consider a "pre-existing condition"?
  • Are you planning on expanding your family in the next year?

With the answers to these questions, look closely at the benefits package, the costs associated with it, the process through which care is accessed, and what restrictions the plan has on who delivers the services.

  • Is your physician or your child's pediatrician included in the plan?
  • How does the health plan and its providers network?
  • In the event of a serious illness or emergency, are the very best services in the community accessible?


When looking for quality, you really need to do some investigating. You may find that two health plans provide the same coverage at the same cost, but one plan is considered to provide better quality care to its members.

Here are some examples of quality questions:

  • How is the plan ranked by Consumer Reports?
  • What is the reputation of the plan you are considering?
  • Is the plan accredited by the National Committee for Quality Assurance (NCQA)?
  • What are the credentials of its doctors, specialists
    and facilities?
  • What type of preventative health services are provided? (Services to look for include: Childhood Immunization, Breast Cancer Screening, Cervical Cancer Screening, Prenatal Care, Cholesterol Screening, and Diabetic Retinal Exam.)
  • How are health services monitored?
  • How closely are medical records monitored for appropriate care?
  • Does the plan report a high level of member satisfaction?
  • What percentages of members file grievances?
  • What is the disenrollment rate?


All of these questions should be answered to your satisfaction before you consider the cost. After deciding which services and features are most important to you and your family, you can begin comparing the costs of various models and plans.

In addition to the quality and coverage offered, the cost of health-care plans will also depend on where you live, the amount of money your company provides for your health insurance, and the package of benefits your company has negotiated for its employees.