Thursday, January 12, 2017

10 Easy Steps to Picking the Right Healthcare Plan

Many of them have rate quotes that you can get on line. There are ten things to consider when choosing a healthcare plan that is right.
These tips give you key information to selecting a provider for you and your family.

1. Specialists – If you have a current condition that needs a specialist, check to see if he is in the network. Do you have to go through a Primary Care Physician first? Many plans do require going through a Primary Care Physician first. Other plans cover them. Don’t get what you won’t need. There’s no need to get more insurance than you’ll use.

2. Doctors – Picking a healthcare plan involves choosing the right Doctor. If you are in a plan with a specific network of Doctors you can use. If you are currently seeing a Doctor, ask if they are on the same plan or network. If you have to choose a new Doctor you can research with the AMA website. They have lists of Doctors that are safe,and knowledgible. The other information is location, hours, and availability. How often is the Doctor at that office and for how long? Another consideration is a waiting list, or a policy of not accepting new patients. A call to the office can clear those questions up.

3. Emergency Visits and Hospital Care – You need to find out what hospitals and emergency rooms are covered on your plan. Do you need to contact a Primary Care Physician first? For instance, I went to the Emergency Room for a itchy, skin rash that was burning. I was suppose to go to my Primary Care Physician first Instead of doing that I went to the Emergency Room and got treated. I was billed for an Emergency Room visit, which was over $200.00. I would never do that again. It’s worth it only if your plan covers the Emergency Room. The hospital coverage is essential to know. Is there In-patient deductible? Usually you have to call to get an authorization. The number is on the back of your insurance card. They give the limits of time for them, such as a certain amount of days.

4. Pre-Existing Conditions – This can vary between plans. Some have no coverage for pre-existing conditions, and others cover it completely. The Health Insurance Portability and Accountability Act provides coverage for pre-existing conditions if you joining a new group, and have been insured for 12 months previously.

5. Prescription Drug Coverage – Many plans have differing coverage for prescription drugs. If you need and are currently using these drugs, then you need to get a plan with the biggest amount of prescription drug coverage. Find out what the cost of your prescriptions are, including generic drugs. Generic drugs are available at a much lower cost to you every time. They are identical to the original contents of your drugs. Any way to bring the cost down, realistically, to you and your family is good. My generic drugs have always performed well for my children and myself.

6. OB/GYN – If you regularly see one, see if they participate with your plan. Check the credentials on the AMA website. You needs the time and availability for the OB/GYN. For women who are planning on having a baby, find out what hospital to go to. How much is the cost of pregnancy and birth at the hospital? You should know ahead of time. There are three bills that you will receive. One for the OB/GYN, one for the hospital, and one for the pediatrician. They come to the hospital after the birth of your baby. You’ll be charged for the visit. Most healthcare plans cover a portion of those expenses. Lastly, a fertility treatment is something to consider when choosing the right plan. Some plans have new coverage for these fertility treatments. Be sure to check the facts.

7. Regular Physical and Health Screening – If you have children find out if well baby checkups and immunizations are covered. Most people like getting a physical every year. Anthem Healthkeepers HMO is my insurance company. I have had them for 7 years now. They cover yearly physicals for my children. For myself, a mammogram is a heatlh screening service that is covered after 40 years old with Anthem.

8. Additional Services – These include Nursing home and hospice, chiropractics care, drug and alcohol rehabilitation, mental health care, and counseling care. Also alternative medicines and experimental treatments. All of these need your attention if you have need of them in the future. Anthem Healthkeepers covers 50% of mental Health services.

9. Costs – The way to compare costs is to find out how much you must pay. Co-payments are the fees you need to pay when visiting your doctor, hospital, or emergency room. Finally, know your limits. Some plans have lifetime limits on how much the health care plan will pay and some have lifetime limits along with yearly limits. Find out what deductibles you will need to pay first before the health care gets in your favor. You will also want to know if your deductible needs to be met before any services can be used. Also, find out what percent the health care will pay after your deductible. Also find out how much it would be to see a doctor outside your network.

10. Exclusions – Look at that exclusion list and see if you have any of those conditions, or will have them in the future.

There are 3 types of Managed Healthcare Plans: ( HMO, PPO, & POS )

HMO is a Health Maintenance Organization provides employers a way to take care of all their employees’ health care needs with reduced costs by negotiating with specific doctors, hospitals, and clinics.

PPO is Preferred Provider Organization is similar to an HMO but they can chose an out of network doctor for services.

POS is point of Service where they chose their own physician who has agreed to a fee that is discounted.


If you’d like a great side by side rate quote, here’s the site to see. It’s called You go on this website, pick what coverage you need, (subscriber, subscriber, spouse, and children.) It lines up the HMO, PPO, and PPO right next to each other with three columns. The first page shows the benefits for each, such as lifetime maximum, annual deductible, office visits, hospital, prescription drugs, and maternity. The next part is rates, you click on the rates. The column has rates for HMO, PPO, and PPO. It goes by age starting at 0-2 and ending at 60-64. It’s the easiest sight to manage and get correct information for healthcare coverage. The beauty is the simplicity of it.

All of these managed care plans vary greatly in their amount of services given and amount of exclusions. Please consider the needs of your self and family when choosing a Healthcare provider. The best policy that fits your circumstances now and in the future. With these tips and suggestions you should be able to make knowledgeable decisions for your healthcare coverage. The targeted information should make choosing the right one easy. It takes all of the guesswork out of it, doesn’t it?


We spent $1.8 trillion (yes, I said trillion) on healthcare in America. The amount for a single person was $5,670. The federal government paid 24%, the state paid 15%, and 55% was privately paid. This was paid by private insurance and out of pocket expenses. The high cost of Healthcare combined with the high number of uninsured people. Getting insurance through your job is one of the easiest ways to get it. For others, trying to get healthcare insurance may be quite impossible to do. That’s the American crisis to not be able to afford a healthcare plan that you so desperately need. That’s why I’ve included these 10 steps to picking a healthcare plan. For those people who can’t afford it there are options to pick from other insurers. Each day these companies are arriving in the nick of time to offer lower rates. Hopefully, these websites can give you some quotes and ideas. With the rising costs I hope we are getting into some solutions for everyone. Gook luck to all of you.

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