Health Insurance Checklist

[A health insurance checklist is a good idea because shopping for health insurance can be confusing. If you do not use some sort of health insurance checklist, it may seem that one plan is a better value than another plan when in fact it is not. When completing the health insurance checklist, be sure to accurately record the annual total out-of-pocket for each plan. Since deductible and coinsurance can be per person or per family (especially with an HSA qualifying plan), make sure you are comparing apples to apples when doing your health insurance checklist. - ed.]

Health Insurance Checklist: What's Most Important to You?

Insurance plans vary. Before choosing a plan, decide what is most important to you. This checklist can help. Put a check in front of those services that are important to you. Then see how many of these services are in Policy #1, Policy #2, and Policy #3. On the checklist, write in the coinsurance or copayment rate, if there is one, and any limits on service.

Remember that the most important service to be covered is hospitalization. If you are not covered for hospital care, then one sickness could cost you thousands of dollars, even hundreds of thousands of dollars.

    Service                             Policy #1    Policy #2     Policy #3
	
-Hospital care
-Surgery (inpatient
 and outpatient)
-Office visits to
 your doctor
-Maternity care
-Well-baby care
-Immunizations
-Mammograms
-Medical tests,
 x-rays
-Mental health care
-Dental care,
 braces and cleaning
-Vision care,
 eyeglasses and exams
-Prescription drugs
-Home health care
-Nursing home care
-Services you need
 that are excluded 
Other issues that are
 important to you:
-Choice of doctors
-Convenient location of
 doctors and hospitals
-Ease of getting
 an appointment
-Minimal paperwork
-Waiting period before
 coverage begins

Which policy is best for you?

Worksheet: What Is Your Best Buy?

It is difficult to determine exactly what you will spend a year on health care. You do not know whether you will be sick 6 months from now and need an operation. Hopefully, you will not.

Using this worksheet, you can begin to make some rough estimates. Much will depend on what service you need or want, how many people are in your family, your age, and other factors. Do you need to have your eyes tested this year? Will you have a mammogram or other cancer screening test? Does your child need immunizations?

Look at your medical and insurance records from last year as a guide to what services you might use this year. Add up the actual costs to you, including premiums. Estimate what you might spend on your health care in terms of deductibles, coinsurance and/or copayments, and services that are not covered.

Compare Policy #1, Policy #2, and Policy #3 to determine which is the best buy for you.

What is your monthly premium?          Policy #1     Policy #2     Policy #3
    Individual:
    Family:
Multiply by 12 for annual cost:    
What is your deductible?
   (if there is one)
    Individual:
    Family:
What is your coinsurance rate
or copayment, if there is one?
   (Note if there is a higher rate
    for special services, such as
    outpatient mental health care.)
Are there any annual limits for
days or services covered and
the amount spent on you?
What is the maximum you will have
to pay out-of-pocket each year?
What is the lifetime limit,
if any,that you will be
reimbursed?
Total estimated yearly cost
to you:

Now look at the checklist of services that are important to you. Is your best buy the same policy that gives you the most services you need?

[When doing the health insurance checklist, look at the limitations and exclusions carefully. It is possible that after getting the policy or evidence of coverage, that you should review your health insurance checklist to make sure that there are not additional items that were not in the marketing literature. All insurers either voluntarily or by state law should give you a "free look" period of 10 or 20 days or so to refuse the plan, so there is time to make the review using the health insurance checklist, and get a full refund if not satisfied. - ed.]

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