THREE STEPS TO CHOOSING A HEALTH INSURANCE PLAN
All health plans have trade-offs. You must decide what is most important to you based on your own personal needs. The information on this site is provided as a tool to help you make your decision. It is designed to be used together with the Health Plans comparison sheet (pdf).
Do the math. Consider premiums, deductibles, co-insurance, etc. Estimate what your out-of-pocket medical expenses for the following year could be for each health insurance plan you are considering.
To make your estimate as accurate as possible, consider the lifestyle/family status and financial status factors listed below. It may be wise to do both an estimate based on an average of your past medical care and an estimate with a higher usage of medical care. This will give you a range of what your expenses could be. This estimate (less premium costs) will also be useful in determining if a health care Flexible Spending Account is appropriate for you, and if so, what your annual contribution should be.
Lifestyle/Family Status Factors to Consider When Estimating Future Medical Expenses
- Are you or a family member planning to have a baby? You will want to pay close attention to hospitalization coverage and costs, well-child coverage, and office visit costs.
- Do you (or a family member) travel often? Will you have a family member who needs coverage in another geographic area (e.g., a child attending college)? Where you receive your care is covered differently on the two plans. This could affect which plan is best for you. Keep in mind any deductibles, co-insurance, and out-of-pocket maximums (discussed below).
Financial Factors to Consider When Estimating Future Medical Expenses
- What is the monthly premium?
- What is the deductible? Where does it apply?
- How much is the co-payment for an office visit?
- What is the co-insurance percentage for services?
- What is the out-of-pocket maximum (OPM)?
- What is the structure of the prescription coverage
plan? Is there a separate OPM for prescriptions?
UIChoice has a three-tiered co-payment plan. When you fill a prescription on these plans, you pay the co-pay. The CHIP plan has a two-tiered plan, but on the CHIP plan you pay the full cost of prescriptions and then you are reimbursed by Blue Cross (after your deductible and co-insurance).
- Will you have to pay more than your deductible and co-payment/co-insurance amount for medical services? Does your plan have a network you can utilize to lower your expenses?
- What are the financial details pertaining to coverage that may be important to you? Things you may want to consider are:
Consultations with specialists
Emergency room care
Home health care (e.g., the services of a licensed private duty nurse)
Hospital room and board
Inpatient hospital services
Maternity services (including pre-natal care and delivery)
Mental health/nervous/substance abuse treatment - inpatient and outpatient – UIChoice covers Level 1 and 2 providers at one level while Level 3 providers are covered with 40% co-insurance. CHIP plans cover any provider at one level.
Prescription drugs and contraceptives
Rehabilitation services (including speech, respiratory and occupational therapy)
Rental or purchase of medical equipment (e.g., crutches or a wheelchair)
Routine eye exam
Skilled nursing facility care
Treatment of chronic conditions
X-ray and laboratory services
Consider the provider access issues below (also keep in mind the Lifestyle/Family Status Factors).
- Do you have to use certain physicians or hospitals? If so, given the plan’s participating providers, who (or where) would you choose for:
- A primary care provider?
- A hospital?
UIChoice covers any provider – Level 1 and 2 providers can lower your out-of-pocket costs, as can BC/BS providers (especially when out of state). The CHIP plan covers any provider, but again, BC/BS providers can lower out-of-pocket expenses.
- Are there treatment locations that would be Level 1 or 2 providers in the UIChoice plan that are convenient to you ?
Weigh your estimates of the possible out-of-pocket costs for the plans you are considering against any provider access issues. Make your decisions based on the factors that are the most important to you.