Figuring out which insurance plan is right for you can be a challenge. To make it easier, Presbyterian Health Plan, Inc., suggests you consider these questions before choosing a plan:
- What is the cost? Generally, the cost is a combination of the monthly premium, the annual deductible, and any uncovered expenses you might incur. (See Understanding Who Pays for What.)
- Is there a maximum out-of-pocket limit? Generally, you should avoid policies that don’t place a limit on out-of-pocket expenses.
- What types of care do I think I’ll need? If your visits to the doctor are primarily for well-care, check out the costs associated with preventive care. If you or your family has a specific illness, make sure you understand the coverage for that illness.
- Who can I see? Most plans offer some kind of network, and it is usually much cheaper to see someone in the network. If you have ongoing care with a specific doctor, ask whether you can continue to see them under your new plan.
- Can I see a specialist? Some plans require that you get a referral to see a specialist and some don’t. Whether this is important to you is a matter of personal preference.
- How do I know if my doctor is high quality? Everyone wants high-quality care. Check to see how your doctor, hospital and care facility compares
- Does it cover my prescription drugs? Many plans offer prescription drug coverage, but not all offer the same level of coverage. If you or your family is on one or more prescription drugs, check to see that they are covered. See Understanding Formularies for more information.
- Is there an annual limit on care? Many policies limit how much they will cover of specific types of care in a given year. If you rely on ongoing treatment in a particular area, make sure that care is covered.
- Is there a lifetime limit on care? Some policies limit the amount of coverage you can receive in a lifetime. Know what the limits are.
- Are there exclusions for pre-existing conditions? Some policies specifically exclude coverage of certain pre-existing conditions. If you have a condition, ask before you buy.
Information on Presbyterian’s plans and coverage can be found in the Benefits Handbook and Subscriber Agreement
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What Does In-Network and Out-of-Network Mean?