There are many health plans to choose from. How do you know the health plan you’re choosing has quality providers? The tips below will help you to choose quality health care.
Choosing a Health Plan
Your health plan affects many things:
- How much choice you have in your health care providers
- What kind of care you receive
- Where you will receive your care
- How much you will pay for your care
For this reason, if you have a choice of health plans, it is vital that you evaluate them carefully and choose the one that best fits your needs.
If you’re trying to dig deeper into the quality of your health plan choices, ask the following questions.
What do current members think of the health plan?
One of the best ways to learn about a plan is to find out what existing members think about it. This information is called “consumer ratings” or “consumer satisfaction information.” Consumer satisfaction data is readily available to consumers in the form of a series of surveys called the Consumer Assessment of Health Plans (CAHPS). The results of CAHPS surveys are typically summarized into reports to help you compare health plans and make the best decision.
Does the plan offer preventive care as well as treatment for illness and injury?
Certain performance and quality measures (how well a health plan actually performs at helping people) are reported in the Health Plan Employer Data and Information Set (HEDIS). States, employers, health plans and other groups use the HEDIS data to prepare and publish reports for consumers. These reports, typically known as report cards or performance reports, provide a comparison of how well health plans prevent and treat illness, and may even provide member satisfaction and consumer ratings. Contact your employer or health plan, or your State Department of Health or insurance commissioner’s office for HEDIS information on a particular health plan.
Other questions you should ask include:
- Does the plan have the doctors and hospitals I want or need?
- Does the plan provide the benefits I need?
- Do the doctors, pharmacies and other services in the plan have convenient times and locations?
- Does the plan meet my budget?
Choosing a Doctor
Choosing a quality physician requires a great deal of care and consideration. If you are already enrolled in a health plan, your choices may be limited to doctors in your plan. However, if you have a choice of plans, you may want to select your doctor first and then choose a plan that includes your doctor.
Decide what you want and need in a doctor.
- Has he or she been rated highly by a consumer group?
- Does the doctor have experience with my condition(s)?
- Does he or she have privileges at a certain hospital?
- Is this physician part of my health plan?
Make a list of potential choices.
Check out quality.
- Find out if a consumer or other group has rated the doctors in your area.
- See if he is recommended by others you know and trust.
- The American Board of Medical Specialties can tell you if a doctor is board-certified. This means that the doctor has completed a training program in a specialty and has passed an exam to assess his or her training, knowledge, skills and experience to provide quality care in that specialty.
- The American Medical Association (AMA) can provide information on training, specialties and board certification about many licensed doctors in the United States. Use the DoctorFinder feature on the AMA’s website at ama-assn.org/.
Contact the doctors’ offices. Be sure the doctor is covered by your plan and is taking new patients. Ask other relevant questions to determine if the doctor will fit your needs, such as average wait times for appointments, if the doctor has experience or specialty in a particular disease, etc. If necessary, ask to speak directly to the doctor over the phone or in person.
Ask a Professional
Wading through all the health plan choices and issues can be confusing and time consuming. An independent licensed health insurance broker can narrow your choices and help you choose a quality health plan with the features and benefits that are right for you. Our brokers at Roper Insurance are experts at helping people find the right plan, and they can help you too. Give us a call or use this handy form to email us today and discover how easy finding the right health plan can be.