As you think about which health insurance plan you’ll choose for next year, there are a number of different factors everyone should review and carefully consider, including:
- Monthly premium
- Yearly deductible
- If prescription drugs are covered
- Whether you have coverage while traveling
- How the plan is rated for quality and customer service
But if you’re living with a chronic condition like diabetes, asthma, heart disease, or arthritis—or if you’ve been diagnosed with a serious illness such as cancer—there are some other factors you’ll also want to think about when selecting your health insurance plan. Ultimately, the goal is to make sure you have access to the care you need from the healthcare providers you prefer.
What to consider when choosing your health insurance plan
Before signing up for any health insurance plan, seek out the answers to the following questions:
- Are the doctors you see regularly and your preferred hospitals included in the plan? Check each plan’s list of participating providers to find out if your primary care physician and the specialists you see to manage your chronic condition are part of the network. If you’ve been diagnosed with a serious illness like cancer, you’ll also want to make sure that all the specialists involved in your treatment (as well as the hospitals or other healthcare facilities where you prefer to receive treatment) are covered by the plan. If the physicians you regularly see are outside of the plan’s network, you could end up paying significantly more out of pocket for your care.
- What are your anticipated healthcare needs? Consider how many times a year you see the physicians who are treating you. Think about how often you visit an emergency room or urgent care provider and how frequently you’ve been hospitalized over the past few years. Will you potentially need surgery or other types of intensive treatment in the coming year? With this information in mind, carefully review the benefits the health insurance plan offers to make sure the various types of care you expect to need will be covered, and that the maximum amount the plan will pay for those types of care isn’t significantly lower than your anticipated costs.
- Are your medications covered? Check the plan’s list of covered medications, called a formulary, to make sure any drugs you take regularly are included. These lists often break medications into several categories—generics, preferred, non-preferred, and excluded. The amount of money you pay out of pocket will be greater if your medications are on the non-preferred or excluded list. Also find out if prescriptions require a co-pay (a set amount you pay each time you fill a prescription) or co-insurance (a percentage of the cost of the medication you pay each time you fill a prescription). If the medications you take are expensive, the amount you pay out of pocket in co-insurance could be significant.
- Do you need a referral to see a specialist or receive certain services? If your care is managed by one or more specialists, you may prefer a health insurance plan that doesn’t require your primary care physician to see you first and refer you to a specialist. A plan that doesn’t require pre-certification for services like diagnostic tests, in-hospital care, and surgery can also help streamline and simplify your access to care.
- Does the plan offer special programs to help you manage your condition? Many health plans offer phone consultations with nurses who can answer questions about your treatment and medications and help you stay on track with your care plan. Plans may also offer discounts on wellness programs that can help you manage lifestyle factors which may affect your condition such as gyms and exercise programs, weight loss plans, smoking cessation, and stress management programs. A health advisor can also connect you with specialists to help you manage lifestyle factors or lessen the impact of side effects caused by treatments you receive for your condition.