Whether dealing with a new plan or a renewal of an existing plan, there are many factors patients should consider before taking action, including deductibles, co-pays and drug costs. Patients should also take into account which physicians and facilities are covered under their health insurance plan, and the cost for receiving treatment out-of-network so that they make informed health care decisions. Additionally, patients should make sure to ask their physicians whether they are participating in plans they are considering.


“We want to make sure Americans choose a plan that is right for them and their families in terms of cost and coverage,” says Robert Wah, MD, president of the American Medical Association (AMA). “It is very important that patients look beyond the big print, color-coded plan designations and prices of insurance plans and check the small print details before making their selections.”

The AMA urges patients to thoroughly review all aspects of the plans they are choosing in order to prevent interruptions in care and higher out-of-pocket costs. Consider the following:

1. Are your family's doctors in the plan? If not, what will you have to pay out-of-pocket for office visits or other services your doctor prescribes? Is the plan's directory of participating physicians up-to-date and accurate? Are there physicians on the list who are still accepting new patients?

2. What does the plan cover? What percentage of your health care costs will you have to cover? If so, how much and can you afford it? How much will you have to pay out-of-pocket for the medicines your family needs? Will you be able to use hospitals, labs and other facilities that are convenient to where you live or work? Does the plan provide access to a sufficient number of specialists that you need? 

3. Does your primary care physician have to receive permission from the insurance company to refer you to a specialist? Does that rule include specialists you see regularly for a chronic condition? Does the insurer use penalties or incentives to induce physicians in the plan to limit referrals in any way?

Source: AMA

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