- Inclusions and Exclusions: Check what services are covered, such as hospitalization, prescription drugs, preventive care, and specialist visits. Be aware of what's excluded, like certain treatments or specific conditions.
- Additional Benefits: Look for value-added benefits like telehealth services, wellness programs, mental health support, and dental or vision care.
- Preferred Providers: Ensure that your preferred doctors, specialists, and hospitals are in-network. Out-of-network care can be significantly more expensive.
- Accessibility: Consider how convenient the network providers are to your home or work location.
- Out-of-Pocket Maximum: The maximum amount you’ll pay in a year, after which the insurance covers 100% of your expenses. This is crucial for protection against catastrophic costs.
- Premiums: The monthly cost you’ll pay to maintain your coverage.
- Deductibles: The amount you must pay out-of-pocket before your insurance starts covering expenses. Also, does it change if you go out of network?
- Co-pays and Co-insurance: These are the costs you pay for services after your deductible is met.
- Current Health Status: If you have chronic conditions or need regular medical care, choose a plan with lower out-of-pocket costs.
- Expected Use: Consider how often you visit doctors, need prescriptions, or require other healthcare services.
- HMO, PPO, EPO, or POS: Different plans offer varying levels of flexibility in choosing healthcare providers and require different referral procedures for specialist care.
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2 个月Great post Ernest! “A plan that meets your specific healthcare needs and financial situation”. Those are the words of someone doing right by the client