As a retired medical malpractice reporter as well as a sales representative for a discount health program, (and mother of three adult sons); I have certainly been around and participated in the family health insurance arena for many years. I would recommend the following when selecting a family health program:
1) Consider the health of each family member; are there problems, do you have a sickly family, for example, is there an asthmatic child or one with ADD, are the parents on medication, for example, hypertension, etc.
2) How often do you have to see your family physician? If you family is fairly healthy: Annual check-ups are probably the norm.
3) In your past; how many times have you had to go to the emergency room?
4) How much did you spend on medicine last year?
5) Why are you contemplating a change in your health policy (if you had one previously)?
6) Consider the deductible. Do you have to satisfy a large deductible?
7) How much are co-payments when you go for an examination? What is the cost of co-payment for x-rays, MRI’s, blood work, emergency room, hospitalization, etc. For example, if someone is hospitalized for two weeks; is the co-payment $100 or $500? Does this have to be paid prior to entering the hospital, at time of discharge, or will you be billed?
8) Are you required to use physicians who are a part of the program? Can you go to any physician? Can you go to your existing physician?
9) Are you billed for medical exams or do you pay at time of visit?
10) What hospitals are a part of the program? Can you go to a hospital near your home?
11) What happens if you are ill or have to be hospitalized while on vacation out of the United States? Will you be covered? Will you policy reimburse another facility?
Is there a co-payment?
12) If you are unpleased with a physician, are you allowed to change to another or do you have to stay a year or until the next open enrollment period?
13) Ask the difference between PPO’s versus HMO’s, etc. For example, when my children were young, I used Kaiser because I could take the children to their pediatrician, and if they needed to see a dermatologist or cardiologist; they were all a part of this same group. Because my youngest son had a heart murmur, he had to be seen frequently; so this plan was the most economical. On another occasion, my middle son fell out of a tree and had to be rushed to the ER; paying a small fee allowed him to be seen and treated by a physician. The oldest had a football injury and had to be treated by an orthopedist; being a part of this plan allowed him to get his medications, x-rays, etc., for a nominal fee – probably $5.00. (I am not recommending this program to anyone – just to share how this Group Plan benefited my family).
14) Does the plan include dental? Or do you have to have a separate dental insurance program? We had a separate program through my employer that assisted the entire family for many years. The children were able to have preventative care until they became adults, without a co-payment. The carrier would pay 80%, and after the dentist was paid; we would pay the balance.
15) Consider a medical discount program, especially if you are healthy. For example, if you go to the doctor for annual check-ups, blood work, mammograms, blood pressure checks, etc., why pay a high monthly premium when you are not utilizing it? There are great family discount programs where you pay a fee as low as $59.93 for the entire family (no matter how many people are in the family). The doctors, pharmacies, and hospitals, etc., are a part of the program and have agreed to discount their services between 10 and 60%; so when you go to the doctor, dentist, chiropractor, for example; you pay the discounted amount. You call prior to going so you know the amount. There are no surprised that way. These programs are affordable, especially for people without any type of medical insurance as well as for those who are healthy.
These are just some of the questions that you should consider before selecting a medical plan. Be aware that some of these might not be answered; however, if the majority are to your satisfaction: join the program for a year, and if you are satisfied, keep it, if not make a change during the next open enrollment period. Most programs are written based on a yearly basis.
Be aware that there are no perfect medical insurance plans; however, if most of your concerns are satisfied – you should join up with the program. The most important factor is that you should not be medically-uninsured! That is the number one reason for bankruptcy and/or homelessness now.