Evaluating a health insurance plan

Investigate doctors and hospitals

Other actions you should take before making a health insurance choice include examining a plan's network on the insurance company's website, then doing some research on the in-network specialists and hospitals.

A good place to start: The Joint Commission (formerly The Joint Commission on Accreditation of Healthcare Organizations), an independent nonprofit organization that accredits and certifies hospitals and health care programs. The commission's website allows you to find out if a hospital or medical practice has received the Joint Commission Gold Seal of Approval.

"(The) bottom line is you want a health plan, all else being equal, that has a very high-quality hospital near you, because that's probably where you will go if you need to be hospitalized," Chollet says.

Think about prescription drugs, too

Another place to look is the National Committee for Quality Assurance, a nonprofit that evaluates health care quality of medical practices, Chollet adds. Consumer Reports' website uses the committee's data on customer satisfaction, preventive services and treatment to rank health insurance plans at the state level.

You'll also want to verify if any plan you're considering will cover the prescription drugs you're taking.

"Every health plan has a drug formulary and if you are systematically on a course of drugs, you want to make sure that that formulary covers your drug," says Chollet.

The covered drugs will likely fall into either preferred or less preferred categories, or tiers. The preferred drugs tend to be generic, more established in the market and less expensive, while the less preferred drugs are usually newer and will have higher out-of-pocket costs for you, she says.

Don't just renew, do shop around

Although it may seem easy to just automatically renew whatever plan you currently have (if it's still available), you owe it to yourself to review any other, possibly newer options you may have, either through your employer or on the private market, advises Mendelsohn.

"Consumers should look at the whole picture and not just the basic price tag," she says. "Even though it may take more time, we strongly recommend shopping (around)."


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