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    Choosing Your Plan

    It takes time to find a plan that fits your needs, and many plans have pre-existing condition exclusions. Be sure to think ahead.

    Are you planning a family?
    Will you need surgery soon?
    Will you be moving out of the area?

    Coverage Through Your Employer/Your Spouse's Employer

    If you or your spouse is employed and want to change plans through your employer, ask when the next open-enrollment period will occur. For the peace of mind that you've chosen the plan that's right for you, allow yourself two months to research your various options.

    If your employer doesn't provide health insurance, you'll need to focus on health plans that offer insurance to individuals. You might also investigate associations that offer members the opportunity to join a health plan.

    Choosing Your Doctor
    Good health plans start with the doctor. The first step in choosing a health plan that's right for you is choosing a doctor who's right for you. If you have a doctor you like, find out the plans in which he/she participates.

    Special Medical Needs
    If you regularly see a particular cardiologist, allergist or any other specialist, you may want a plan that lets you continue doing so without a referral. (This is especially true when choosing an HMO, which may require an authorization to see certain specialists.) Lastly, think of the hospitals and health facilities you like.

    Do certain facilities specialize in medical areas that are of particular importance to you?
    Is one facility more convenient than another?
    Find out which hospitals are affiliated with which plans.

    Ask for an insurance brochure for each plan you're interested in. Follow our checklist.

  • You're single, you earn a good wage, and (lucky for you) you're the picture of perfect health.
    Since you rarely see a doctor, your best bet is to choose a plan with a low monthly premium and a higher co-payment. But you should also look for a plan with good coverage in areas that are important to you, such as routine physicals and emergency care.
  • You have a family of four and your oldest is about to start kindergarten.
    You will soon be seeing a pediatrician more than you see some friends. You'll want a plan with low co-payments because those visits will really add up. Immunizations, check-ups and prescriptions should all be covered expenses. If you already have a pediatrician you like, choose a plan with which he/she is affiliated. You'll also want to make sure a participating urgent care center and hospital are nearby.
  • You're married and planning a family.
    You need a health plan with good maternity and well-child care. Maternity care should include prenatal, delivery and nursery care that begins at the moment of birth. Ideally, you should also plan for unforeseen circumstances like emergency Caesarean section and infertility problems. Well-child care will be important to monitor the progress of your healthy baby until 2 years of age. Routine checkups and immunizations should be part of the coverage. Look for a plan with low co-payments since you'll be seeing your doctor a lot.
  • You’re a 40-50 year old with a modest monthly income.
    You have just been diagnosed with a knee problem for which you must undergo ongoing treatment. You'll need a health plan that lets you see the specialists you want as often as you want. You'll be taking prescriptions, so you'll want to make sure those are covered expenses. Since your income is modest, low co-payments are important. You may pay a higher premium to get the coverage you want, but the advantages will be worth every cent.

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