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Choosing the medical plan that’s best for you

This is the time of year when many Americans are asked to evaluate their present medical coverage and make some decisions about the future – decisions that will, in most cases, be binding until this time next year.

If you are working and have medical benefits from your employer or union, you will soon be receiving information about your health coverage. You owe it to yourself and your family to learn as much as you can before committing yourself.

Observe the enrollment deadline: You usually have only a few weeks to decide which health plan option to select. Read your benefits materials carefully, so you will be able to make an informed decision.

Look at the costs: Changes in deductible and co-payments may raise your costs, so spend some time calculating how a change will affect your budget.

Traditional coverage: This is the familiar fee-for-service plan that covers a percentage of the charges from your health care provider. Some employers no longer offer it.

PPO or HMO? Preferred Provider Organizations and Health Maintenance Organizations differ in significant ways:

• PPOs are networks of health care providers that enable you to get the most for your health care dollars by visiting a provider who participates in the network. Some PPOs will let you use health care providers from outside the network, but you will be expected to share more of the cost.
  
  
• HMOs come in several forms. Some offer services at clinics, others contract with physician groups or individual doctors. You choose a primary care doctor from the HMO’s list, and that physician manages your care and provides necessary referrals to specialists who are also in the HMO network.

If you are considering enrollment in one of these plans for the first time, check with your doctor or doctors to see if they participate now in the network you are considering and if they intend to continue doing so through the year of 2001.

Prescription drug coverage: Many health plans offer prescription drug coverage on a sliding scale based on the cost of various medications. Generic medications are more affordable than brand-name products, and this is reflected in a lower co-pay for you. An additional way to economize is to purchase medications through a mail order service instead of at a retail pharmacy.

Helpful details about health plan choices can be found on the Web site of the Employer Quality Partnership.

October 19, 2000

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