What YOU Need to Know to Choose the Best Health Plan

What YOU Need to Know to Choose the Best Health Plan

Asking yourself some important questions about your health care now can save you some major headaches later.

  • Did you know that getting something "checked out" at the doctor's is not the same thing as a "check-up"?
  • Have you ever assumed that something was covered by your insurance, only to be smacked with an alarming bill weeks later?
  • Are you sure that you're setting yourself up for adequate health care coverage later?

To get the inside scoop, we've spoken with Dr. Soma Mandal, an internist with a private practice in Manhattan.

"Office Visits" are Different From "Check-Ups"

While many patients use the terms "getting something checked out" and "going for a check-up" interchangeably, there's actually an important distinction. A check-up is a screening to make sure everything's going well with your health—not a visit to treat an actual problem. "If you're coming in for a complaint," she says, "that is automatically classified as an office visit."

Some health insurance plans cover free check-ups every year, but may have high deductibles for all other expenses. So, be aware that "free check-ups" don't necessarily translate to free office visits when something's wrong, especially if your plan features a high deductible!

Dr. Mandal offers up a real life example: "I had a patient a while back who thought he was coming in for a 'check-up' to look into some chest pains. I needed to send him to a cardiologist, and as he had a high-deductible HSA, he ended up having to pay for the visit himself."

Health Insurance: One Size Does Not Fit All

When deciding on a health insurance plan, think of your family history: Does anyone in your family have diagnosed medical conditions? If so, what's your genetic relationship to that person? Use this knowledge to inform your lifestyle habits, regular check-up schedule and health insurance plan.

Also think about your own time line: Are you considering starting a family in the near future? If so, what parts of the pregnancy and birthing process are covered by insurance? What about coverage for the baby?

Don't Forget the Cost of Medications

According to Dr. Mandal, most medications fall into one of three pricing tiers, the third of which tends to require higher co-payments. Ask your current or prospective health insurance for a pharmacy plan, which should include a formulary to tell you about medications. Most pharmacy formularies will list all common medications in one of three tiers.

Dr. Mandal recommends estimating the cost of medications you might need regularly when you're older: "Let's say both my parents have hypertension and I'm a 45 year old female with borderline blood pressure. I'd make sure the medications my parents are taking fall within the 1st or 2nd tier of my insurance plan (in case I'll eventually have to take them myself)."

Find a Physician You Trust

"Doctors are people too," Dr. Mandal says. "We're human beings. The first thing I'd do to find a good physician... is to ask your friends and family members if they've had good experiences with a certain doctor."

Pay attention to your ability to secure appointments within a reasonable amount of time, and according to your schedule. After all, if you were to get sick, you must be able to see your doctor as soon as possible. If morning or lunchtime is your only chance to squeeze in an appointment, make sure that your doctor is available during those times.

Two Must-Dos for All Women Over the Age Of 18

An annual pap test, and a biannual check-up for updates your blood pressure and cholesterol.

To learn more about Health Insurance and Healthcare Planning, check out our Health Insurance 101.


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