1. Coverage & Benefits:
- Types of services covered: Does the plan cover hospitalization, doctor visits, emergency care, preventive services (like annual checkups), prescription drugs, mental health, maternity care, etc.?
- Network of providers: Does the plan limit you to a specific network of doctors and hospitals (like HMOs) or offer more flexibility to see providers outside the network (like PPOs)?
- Exclusions: Are there specific treatments or pre-existing conditions not covered by the policy?
2. Costs:
- Premiums: The amount you pay regularly (usually monthly) to keep your policy active.
- Deductible: The amount you need to pay out-of-pocket before your insurance coverage begins.
- Copays: Fixed amounts you pay for particular services, like doctor’s visits.
- Coinsurance: The percentage of costs you share with the insurer after meeting your deductible.
- Out-of-pocket maximum: The maximum amount you’ll pay out-of-pocket in a year, after which insurance often covers 100%.
3. Plan Types:
- HMO (Health Maintenance Organization): Usually lower premiums but restrict you to a specific network of providers.
- PPO (Preferred Provider Organization): Offers more flexibility to see out-of-network providers, but with higher costs.
- EPO (Exclusive Provider Organization): A hybrid, offering a network like an HMO but may allow out-of-network services in some cases.
- POS (Point of Service): Combines HMO and PPO features; you might need referrals to see specialists within the network.
4. Additional Features:
- Waiting periods: Some plans impose waiting periods before coverage for certain conditions kicks in.
- Coverage limits: Most policies have annual or lifetime limits on how much they’ll pay.
- Prescription drug coverage: Details on prescription drug formularies (list of covered drugs) and their cost tiers.
- Customer service & claims process: The reputation of the insurer for handling claims and providing support.
Important: No single “best” policy exists. Carefully compare these features across different plans to choose the one that aligns with your healthcare needs and budget.