How much health insurance coverage should I have?
How much can you afford? As mentioned above, this comes down to what you can afford on a monthly basis in premiums compared to what you may need to pay out of pocket when you commence to use the health insurance benefits. For example, say you have a PPO plan. You can have a zero deductible, $10 co-pay plan, which would be a very rich plan in terms of benefits and pay a great deal in monthly premium. However, you could change it to a $250, $500 or $750 deductible plan with a $20 or $30 co-pay plan and thus pay far less in monthly premiums given that you have agreed to pay the deductible first, out of your pocket. In conclusion, to determine how much coverage you need, comes down to a cost-benefits analysis that you must first engage in to determine the amount of insurance you may want to purchase.
What are the most important factors I should consider when choosing a health insurance provider?
First, given that Kaiser, in some areas, is a large provider of health benefits, it is necessary to distinguish Kaiser from all other health insurance companies. Kaiser is a one stop shop type of arrangement. Meaning, when you choose Kaiser, which inevitably will be very cost efficient, you do not necessarily choose your doctor. You go to Kaiser and are given physicians, a pharmacy, a dentist and vision experts. Kaiser takes care of everything "in-house." All other insurance companies, buy physician networks. Meaning that physicians belong to Independent Physician Associations, ("IPA's") and the insurance company will negotiate with that IPA and agree upon what they will pay for particular services both in HMO and PPO networks. Therefore, when you choose a health insurance plan, you need to make sure that your providers are in the network attached to the insurance plan that you just bought. Your particular physician may not be "in-network" for the HMO from your carrier, but may be in-network for the PPO plan from your carrier. Therefore, the difference between Kaiser and all other insurance companies comes down to freedom of choice. Whether you want to the freedom to choose those experts and physicians that you want to see for yourself or your family members, or whether you are happy with the convenience of the one stop shop that Kaiser affords their members.
What are the most important factors I should consider when choosing a health insurance plan?
First, you choose a broker based on experience and added value services as well as recommendations from close friends who may have just gone through this process. Then you need to determine your current financial resources in addition to your health history, both past and expected events in the near future, i.e., pregnancies, operations. One important question is whether you would rather pay more in monthly premiums and then pay less money out of pocket when you use your health benefits or whether you would rather pay less in monthly premiums and more in out of pocket expenses when you do use your health insurance. Second, you need to find out whether the network of physicians and professionals that you use are going to be in the network of the health insurance plan that you may buy. For example, HMO's, which at one time were the most prevalent health plan around, are far less popular now with physicians in that the insurance companies pay the physicians far less for HMO patients than PPO patients. As a result, there are fewer doctors on HMO networks than there are physicians in PPO networks.
