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3 STEPS TO CHOOSING A HEALTH INSURANCE PLAN – MERIT

 

All health plans have trade-offs. You must decide what is most important to you based on your own personal needs.  This sheet is provided as a tool to help you make your decision.

 

STEP ONE: Estimate what your out-of-pocket medical expenses for the following year could be for each plan you are considering.

 

To make your estimate as accurate as possible, consider the lifestyle and 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 and Family Status Factors to Consider When Estimating Future Medical Expenses

a. Are you or a family member planning to have a baby? Premiums may change when you switch from Single to Family coverage.  You will also want to pay close attention to hospitalization coverage and costs, well-child coverage, and office visit costs.

b. Do you (or a family member) travel often? Non-emergency out-of-area medical care requires prior approval with the managed care plans: Blue Advantage and Blue Access.

c. Will you have a family member who needs coverage in another geographic area (e.g., a child attending college)? When you are temporarily out of the area, some plans cover only life threatening emergencies (see “b.” above). Under Blue Advantage, you and/or family members must see your primary care provider for all routine care. Under Blue Access and Blue Advantage, if you will be traveling long-term or have dependents or a family member out of the area for an extended time, you should review the Guest Membership component of the policies (P.32 of the coverage manual for Blue Access and P.33 of the coverage manual for Blue Advantage).

Financial Factors to Consider When Estimating Future Medical Expenses

What are the financial details pertaining to coverage that may be important to you?  Things you may want to consider are:

 

Office calls
Emergency room care
Hospital room and board
Preventive services
Treatment of chronic conditions
Inpatient hospital services
Consultations with specialists
Prescription drugs and contraceptives
Hearing exam
X-ray and laboratory services
Physical therapy
Routine physicals
Immunizations
Allergy treatments
Skilled nursing facility care
Hospice care
Well-child care
Routine eye exam
Maternity services (including prenatal care and delivery)
Home health care (e.g., the services of a licensed private duty nurse)
Rental or purchase of medical equipment (e.g., crutches or a wheelchair)
Rehabilitation services including speech, respiratory and occupational therapy
Chiropractic care – Program III Plus and Iowa Select plans cover chiropractic as any other physician.  Managed care plans sometimes require prior approval and may have a limited number of providers.

 

STEP TWO: Consider the provider access issues below, and keep in mind the Lifestyle and Family Status Factors. 

 

a. Do you have to use certain physicians or hospitals?  If so, given the plan’s participating providers,  who (or where) would you choose for:

1. A primary care provider?
2. Specialists?
3. A hospital?

Blue Advantage and Blue Access  are  managed care plans and require the use of specified providers. Program III Plus and Iowa Select plans cover any provider, but BC/BS providers can lower out-of-pocket expenses.  Preferred providers with Alliance Select result in additional savings.

b. Are the treatment locations convenient?

 

STEP THREE: Weigh your estimates of the possible out-of-pocket costs for the plans you are considering against the provider access issues.  Make your decisions based on the factors which are the most important to you.