How to Evaluate a California Health Insurance Plan
The Three Most Important factors: Benefits, Price, Providers
Health care plans can differ in hundreds of ways. We simplify the process of comparing different plans by focusing on three factors: benefits, price, and providers.
1. Benefits: Once you’ve narrowed down the type of plan and the general benefits you’re interested in, you should look closely at the details of what’s covered and what’s excluded in specific plans. We advise looking at just a few of the most important benefits, like those listed below:
- Doctor’s office visit co-payment, which can range from $5 to $20 per visit
- Hospital co-insurance percentage, which is typically 100 percent to 80 percent
- Prescription medicine co-payment for generic and brand-name drugs
- Out-of-pocket maximum, or “stop loss,” after which the insurance company pays 100 percent of costs.
2. Price: On a monthly basis, how does the price for a plan compare to other plans with similar benefits? Everyone wants the lowest priced plan with the most/best benefits; we can help you understand the trade-off between benefits and price. See How Do Insurance Companies Price Health Insurance? There are many ways to lower your cost and still offer your employees top-quality health insurance plans. You should explore some of the innovative plan designs including:
3. Providers: This is where the rubber meets the road. Are the doctors that you and your employees want in the provider network of the plans you’re considering? We can help you compare different plans’ provider networks. We can also give you advice on provider-related issues like how best to choose providers and different plans’ policies regarding changing providers. (Regarding the first issue: While word-of mouth referral is a popular way of finding a doctor, it may not be the best way; your preferences and medical condition may be vastly different from those of other people. If you’re looking for a primary care physician (PCP), we recommend visiting the office of the doctor you’re considering and speaking with the people there; see if you have a positive experience. Regarding the second issue: Most HMOs allow you to change your PCP once a month, if you notify the insurance company by the 15th of the month for a change beginning the first of the following month.)