One simple step to make sure your health care plan is compatible with your health care providers (including clinics, hospitals, pharmacies, mental health services, dentists, and others) is to CALL AND ASK! This seems to be wise advice for everyone, whether they are selecting coverage from their employer, enrolled in public insurance (such as Medicaid/Medicare), or buying health insurance individually; the challenge seems to be universal.
ISU Extension’s workshop called Smart Choice: Health Insurance devotes some time to defining the different types of networks found in different insurance plans. (For full info, check out “Types of Health Insurance Plans,” one of our Smart Choice handouts). In brief, there are three most common types:
- the closed network of the HMO/EPO,
- the referral-required POS model, and
- for coverage when you go to a clinic out of state or want the option to see a specialist without referral there is the PPO plan.
News Flash: ANY insurance plan can have limitations that will put you in a position of not having coverage. The changes can result from institutional events (such as privatization of Iowa’s Medicaid and Expanded Medicaid programs) or private contract negotiations between health providers and the insurance industry. Changes are common, so don’t assume what worked last year is true for the next 12 months. The “Call and Ask” rule is a good rule to apply every single year.
In our workshop, we also ask participants to rank 5 items in order of importance to them in choosing a health insurance plan. The five items are:
- Health care services needed for the next year
- Doctors and health care providers in the insurance network
- Monthly premiums
- Deductibles, co-pays, and coinsurance
- Prescription drugs covered by the plan
Right now given the changes taking place in health insurance coverage, I’d put networks (2nd bullet) at the top of my list.