What Benefits Are Covered?
Most plans provide basic medical coverage, but the details are what count. The best plan for someone else may not be the best plan for you.
For each plan you are considering, find out how it handles:
- Physical exams and health screenings.
- Care by a specialist.
- Hospitalization and emergency care.
- Prescription drugs.
- Vision care.
- Dental services.
Also ask about:
- Care and counseling for mental health.
- Services for drug and alcohol abuse.
- Obstetrical-gynecological care and family planning services.
- Ongoing care for chronic (long-term) diseases, conditions, or disabilities.
- Physical therapy and other rehabilitative care.
- Home health, nursing home, and hospice care.
- Chiropractic or alternative health care, such as acupuncture.
- Experimental treatments.
Some plans offer members health education and preventive care, but services differ.
Ask question such as:
- What preventive care is offered, such as shots for children?
- What health screenings are given, such as breast exams and Pap smears for women?
- Does the plan help people who want to quit smoking?
What is most important to me in a plan?
In choosing a plan, you have to decide what is most important to you. All plans have tradeoffs.
Ask yourself these questions:
- How comprehensive do I want coverage of health care services to be?
- How do I feel about limits on my choice of doctors or hospitals?
- How do I feel about a primary care doctor referring me to a specialist for additional care?
- How convenient does my care need to be?
- How important is the cost of services?
- How much am I willing to spend on premiums and other health care costs?
- How do I feel about keeping receipts and filing claims?
You might also want to think about whether the services a plan offers meet your needs. Call the plan for details about coverage if you have questions.