CHOOSING A HEALTH PLAN

QUESTIONS TO ASK BEFORE YOU SIGN UP

For individuals choosing a health plan during open enrollment periods this fall, Consumers Union, the publisher of Consumer Reports, has developed a list of questions to ask before signing up with any particular plan. While no list of recommendations can fully address the issues that consumers face, the following tips are an attempt to provide you with guidance as you make this important decision.

While choosing a plan may seem daunting, if you have this choice, consider yourself lucky. More than forty million Americans don't have any form of health insurance. Others who have insurance don't have any choice about which plan will provide them with care. So take the time to think carefully about your needs and your options, and then make a well-considered decision.

BEFORE YOU SIGN UP…

ASSESS YOUR FAMILY'S NEEDS

While you cannot predict all your needs, it pays to make a list of all the services you expect to need in the coming year and then evaluate each plan according to your own list. Consider these questions as you assess your family's needs:

IF YOU NEED SPECIAL TREATMENT, YOU SHOULD CONDUCT EXTRA RESEARCH

The general health plan brochures you receive from your benefits office will not answer specific questions. Ask your benefits office to find out if and exactly how a plan will cover your special needs. Ask to get a copy of the "evidence of coverage" from your benefits office or the plan itself to determine whether you're covered. Find out before you sign up.

HMO OR PPO?

If your employer offers you a choice between a Health Maintenance Organization (HMO) and a preferred provider organization (PPO), you need to figure out which type of plan best meets your needs. However, these days HMOs and PPOs are looking more and more alike. Generally, a PPO allows you more choice in seeing a doctor, but at a higher cost. You may have an annual deductible you must pay before the PPO begins to pay for any claims. An HMO may have lower copayments and premiums, but may restrict your freedom to choose a doctor (such as a specialist) by requiring you to first obtain a referral from a primary care doctor.

A recent Consumer Reports survey of 83,000 readers found that the main problem for consumers with PPOs was billing, especially when going out of network for care. For HMOs, the survey found the main problem to be obtaining needed care and choosing doctors. Here are some things to keep in mind when choosing between an HMO and a PPO:

TAKE A GOOD LOOK AT YOUR FINANCES

Don't choose a plan with high out-of-pocket expenses if you can't pay for them. If possible, pick a plan that will provide you the services you need at a price you can realistically afford.

HMO ENROLLEES SHOULD ALSO ASSESS THEIR MEDICAL GROUP

HMOs (except for Kaiser) must contract with groups of doctors to provide care to their enrollees. In the past few years, several medical groups have gone insolvent and have not been able to provide care to HMO enrollees. When that happens, the HMO must find other doctors to take care of enrollees. To avoid any disruptions in your ability to see a familiar doctor, you should get more information from your benefits office and the HMO about the financial stability of the medical group that provides care to that HMO's enrollees.


ONCE YOU'VE ASSESSED YOUR NEEDS AND RESOURCES,COLLECT INFORMATION ON THE PLANS AND THEIR MEDICAL GROUPS

IF YOU'VE ALREADY ENROLLED IN A MANAGED CARE PLAN…

In its October 2001 issue, Consumer Reports magazine rated HMOs throughout the country, based on survey data from 83,000 subscribers. Individual copies of that study are available to the public at a charge of $7.75 by calling 1-800-766-9988 and requesting reprint #9876. Information on bulk reprints (10 copies or more) can be obtained by writing to Reprints and Permission, Consumers Union, 101 Truman Avenue, Yonkers, New York 10703-1057. (News media can receive copies by contacting Michael McCauley at 415-431-6747.)

Consumers Union also rated Medicare HMOs in a recent report titled "Guide to California Medicare HMOs." To order free copies of this report, call 888-430-2423. The report may also be viewed online at www.consumerreports.org or www.chcf.org.

Consumers Union, publisher of Consumer Reports, is an independent, nonprofit testing and information organization, serving only the consumer. We are a comprehensive source of unbiased advice about products and services, personal finance, health, nutrition, and other consumer concerns. Since 1936, our mission has been to test products, inform the public, and protect consumers.

 

Consumers Union West Coast Regional Office
2001


View Files Sorted By Office: Consumers Union OPI, New York - Washington DC Office
West Coast Regional Office - Southwest Regional Office - Consumer Policy Institute

  
the entire directory only this category
[More search options]

[ Health ] [ Finance ] [ Food ] [ Product ] [ Other ]
[ About CU ] [ News ] [ Tips ] [ Resources ]
[ New Files ] [ Home ]


Please contact us at: http://www.consumersunion.org/contact.htm
All information ©1998-2002 Consumers Union