Which type of health insurance is right for you?

Whether you are eligible for group insurance or choosing an
individual plan, you should carefully compare costs and coverage.
Be sure to compare:
1. Premiums.
2. Coverage/benefits.
3. Access to doctors, hospitals, and other providers.
4. Access to after hours and emergency care.
5. Out-of-pocket costs (coinsurance, copays, and
deductibles).
6. Exclusions and limitations.
Even if you do not get to choose your health plan—for example, if
your employer offers only one plan—you still need to understand
your coverage. What kind of services are covered by the plan? What
steps do you need to take to get the care you and your family
members need? When do you need prior approval to ensure
coverage for care (for example, elective hospitalization for scheduled
surgery)? How are benefits paid; do you have to submit a claim?
Make sure you understand how your plan works. Don’t wait until
you need emergency care to ask questions.

If you are choosing between indemnity and managed care plans,
remember that they may differ in several important ways, including:
• How you access services.
• How you obtain specialty care.
• How much and sometimes how you pay for care.
Despite these differences, indemnity and managed care plans share
some features. For example, both types of plans cover a wide array
of medical, surgical, and hospital services. Most plans offer some
coverage for prescription drugs. Some plans also have at least partial
coverage for dentists and other providers.
The major difference between indemnity (nonnetwork
based coverage) and managed care
plans (network-based coverage) concerns
choice of doctors, hospitals, and other
providers; out-of-pocket costs for covered
services; and how bills are paid.
Be sure to check on the physicians and hospitals
that are included in the plan.