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Selecting a Family Healthcare Plan

Factors to Consider in Finding the Suitable Family Health Insurance Plan

The sheer volume of family health care plans out there can be overwhelming, especially when you're choosing a plan to cover your whole family. You've got to balance the different types of plans available, the real needs of your family and any pre-existing conditions that need coverage with health care that's affordable. Sit down and give the following areas some serious thought so that you can make an informed and educated decision on your family healthcare plan.

Additional Services

You'll probably want dental services for your family, but sit back and think about other special services that you might need. If you've got adolescents, braces and monthly visits to the orthodontist might loom in the future. If you're planning to have children, that will require extensive medical care for the duration of the pregnancy and beyond. If you or your spouse wears glasses, you'll need vision coverage. Think about any prescriptions or chronic conditions that require regular care or specialist visits. How much will a specialist cost? List out costs that you currently pay for these services so that you can compare the family plans against your existing coverage.

Pre-Existing Conditions

If you or a family member has a pre-existing condition, take the time to make sure it will be covered under the new plan. Typically, if you're joining an employer's plan and were covered for the last twelve months, any pre-existing conditions will be covered under the Health Insurance Portability and Accountability Act (HIPAA). Take the time to read the fine print before you sign any papers, so you can relax knowing you are covered.

Prescription Drug Coverage

If you or a relative needs prescription medication, explore the costs for this now to avoid paying through the nose later. Find out whether the medication you need comes in a generic form, and what the costs are for the brand-name versus the generic. Compare the costs given to your current costs to get a ballpark figure. Prescription drug coverage varies widely across plans. Some plans may offer very extensive coverage, while others offer limited coverage. Other plans cover some classes of prescription medication, but not all.

Costs

Once you have a better idea of what you need, it's time to crunch the numbers. Review family healthcare plans that offer the services that you just determined your family needs. Look at the monthly cost of the plans. While your employer may pay a certain dollar amount per month toward your health care, you will be on the hook for the rest. Can you afford it?

Exclusions

Healthcare plans list out what is covered in their plan and what is not covered. The latter is called the exclusions list. Once you know what you can afford to pay on a monthly basis, review all plans that meet your need to see what services or conditions they do not cover. If a plan offers no coverage for a condition you have or may develop, consider purchasing a different plan.

Types of Plans

HMOs or Health Management Organizations offer relatively low-cost care but provide fewer services. You're typically limited to doctors in their network, need a referral for specialist services, and are not covered for seeing providers outside of their network. Preferred Provider Organizations (PPOs) do not limit you to one primary-care doctor, so you can visit in-network specialists without needing that referral. You can use out-of-network caregivers, but will see higher fees. The Point-of-Service (POS) plan combines the HMO and PPO. In this type of plan, you can see out-of-network doctors like with the PPO. In-network, you have a primary care physician that must make referrals within the network. If you seek out-of-network care, your costs are higher. Inside the network, your costs stay low. Fee-for-Service or indemnity plans are both traditional and liberal in their coverage. With these plans, you pay for costs up-front and your insurer reimburses you for around 80 percent of healthcare costs. Knowing the medical lingo can help you navigate between family plans.

 
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