How to Evaluate Health Plans

AvMed is focused on helping Members stay on the path to better health. When it comes to finding the right coverage for you and your family, seek the advice of an insurance professional to find the plan that's right for you.

Whether you are looking to purchase insurance as an individual or you need to evaluate more than one option offered by your Employer, there are lots of things to consider. Just follow this step-by-step guide:

 


Step 1: Ask yourself what you’re looking for

I want a plan that gives me the best value for my money.
Consider a plan with:

  • Affordable copayments for doctor visits
  • A deductible between $1000 and $2000
  • A Network that includes your preferred physicians and hospitals
  • Generic prescription drug coverage
 

I want a plan with the lowest possible cost.
Consider a plan with:

  • A deductible of $2,500 or higher
  • Emergency and major medical coverage only
  • Limited benefits, limited doctor visits
  • Discount prescription drug cards
 

I want a plan that provides the most complete coverage possible.
Consider a plan with:

  • A deductible of $1,000 or less
  • Low copayments for doctor visits
  • The broadest Network of healthcare providers
  • Full prescription drug benefits

Step 2: Decide what you need

There is no such thing as a one-size-fits-all insurance policy, so it’s important to figure out what your needs are. Where is the nearest in-network hospital? Find out if the doctors, hospitals, and pharmacies in the plan are convenient for you. Do you have any health conditions?

You may also benefit from educational support or a Care Management program that helps you manage your specific condition. What kind of medical care do you need? If you are on prescription drugs, you will want to find a plan that includes the medication you need. If you need to see a Specialist, you will want to ensure that you can find one in your plan’s Network.
 
Once you’ve taken stock of your needs, then it will be helpful to compare premiums and deductibles to make the decision about what plan is right for you.

Step 3: Understand the costs

There is an entire new vocabulary when it comes to health insurance costs.

 

PREMIUM: This is the monthly payment that keeps your health insurance policy active. It is determined by factors like age, lifestyle, and the city where you live.

DEDUCTIBLE: This is the amount you have to pay for medical expenses in order for coverage to kick in. The deductible may not apply to all services. You can choose from a range of annual deductibles.

COPAYMENTS: This is a fixed amount that you are required to pay when you receive care.

COINSURANCE: This is a percentage-based amount that you are required to pay when you receive care, the rest of which is paid by the insurance company.

OUT-OF-POCKET MAXIMUM: This is the set limit on the amount you are responsible for paying for healthcare services in one year.

Step 4: Select a plan

When it comes time to choose a health plan, there are different ways to shop, compare, and apply for coverage if you are shopping as an individual. If you are choosing one of the options offered by your Employer, you can choose during your company’s open enrollment period.
   
Apply with the Insurance Company— If you know what carrier’s plan you would like, you can apply directly by contacting them by phone or on their website.
   
Apply with a Licensed Agent—Insurance Agents and Brokers can help make the process easier by comparing options and providing expert advice.
 
Apply by Comparing Quotes—There are several online quote services that can connect you with local Agents and provide instant quotes.

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