To determine what health plan option is best it can be a good idea to consider three of the essentials, i.e., health, finances and quality of service. While obtaining the best coverage for one's health maintenance and treatment of health problems is usually of more importance, choosing a cost effective plan is also relevant. Several types of health care coverage exist and may be available depending on one's circumstances, age, finances and health coverage needs. This article will illustrate in three steps, a way by which one can go about deciding which health plan option is the best choice.

Step 1: Identify Coverage Qualification

A good first step in determining what health plan option is best is to take a look at personal medical backgrounds, open enrollment plans from employers, and match one's health needs to an appropriate coverage. For individual insurance, medical background questions, age and gender determine if one will qualify for insurance and what premium level one fits into for each plan. Typically, females in the birthing years tend to have higher coverage costs with individual plans. 

If one is able to register for Medicare or employer health insurance, coverage is generally guaranteed during open enrollment periods. In such cases, medical history is not as important a factor as with individual health coverage. Summaries of each of the three major categories of health insurance are provided below to aid in identifying which category one can benefit most from.

Employer Health Insurance Plans

Whether one's employer is a private corporation, public company or Government agency can greatly affect what health care coverage plans are available. Additionally, self employed persons may also qualify for insurance coverage specific to their type of occupation.

A few examples of health coverage are the Federal Employees Health Benefits Program, Group Health Insurance Plans and Health Savings Account plans. Depending on the employer's financial goals, and contracts with the health care networks, insurance providers and health care organizations, the plans available to employees can vary and may also include dental, accidental and vision insurance coverage.

Medicare and Supplemental Insurance

Medicare health insurance is divided into to four categories, namely parts A, B, C and D. Each type covers a certain kind of need and determining if one can make use of each type has to do with if one is already enrolled in the other types. For example, if one is registered for medical services which is type B Medicare coverage, one may then apply for part D which is prescription drug coverage.

Since Medicare is not full health care insurance in the sense that not all costs are covered, one may also choose a supplemental health insurance for some of the needs not covered such as long term care supplemental insurance. Supplemental health insurance can be obtained from private insurance providers.

Individual Insurance Policies

Individual insurance policies are policies chosen outside the confines of employer or government provided coverage. These plans are paid for by the individual and are subject to approval based on medical history and application information. There is generally no open enrollment for these kind of plans. A few reputable companies that provide individual health insurance are AARP, Blue Cross/Blue Shield and Kaiser Permanente. A wide range of plans are available to individuals based on their unique health requirements, budgets and location.

Once one has identified which major category of health insurance one can make best use of i.e. employer, Medicare or individual, one can then review the types of plans within that category.

Step 2: Review the Types of Health Care Plans Available

There are many types and combinations of health plans to choose from within each of the major insurance categories described above. For example, there are drug prescription plans, PPO plans, HMO plans, high deductible plans, budget plans, supplemental plans and so forth. A few of these plans are described as follows to illustrate the choices one may have. After becoming familiar with the types of plans, one can then assess which one is most suitable based on doctor access, gatekeeper system preferences, cost, quality, hospital care etc.

·          Preferred Provider Organization Plan (PPO): PPO's are a network of doctors, urgent care providers and other health service providers that collaborate with insurance companies to offer medical services. Under this type of plan, the insured is limited to the network of health service providers within the plan; however, out of network services may be used for a higher visit co-pay. Premiums for this type of plan tend to be lower, but out of pocket expenses such as co-insurance costs and deductibles can also be higher.

·          Health Management Organization Plan (HMO): An HMO is more than a network of health service providers in the sense it is an organization, within which an array of health care providers participate. HMO's make use of a gatekeeper system and closed network, i.e., a primary care physician must approve additional care from specialists within the organization rather than being able to directly consult a specialist of individual choice. Coverage with these types of plans can be more effective for major medical needs such as surgery.

·          Point of Service Plans (POS): POS plans are also a network like PPO's but have more financial benefits from utilizing the network such as low out of pocket co-pay costs and minimal to no deductibles. The POS insured may also choose to go out of network for one's health services at an added cost. The POS plan does use a gatekeeper system within the network.

Other types of health insurance plans include Medicaid, State Health Insurance Plans and Government sponsored Children's Health Insurance Plans (CHIPS). These previous plans are usually subsidized and are income contingent plans meaning they are only available to people with income levels below a certain point. Obtaining health care and service through plans such as Medicaid can involve extensive bureaucracy and may not me accepted by private health care providers.

Step 3: File Paperwork and Allow Time for Processing:

Once one has identified coverage availability, qualification and become familiar with the benefits, disadvantages and costs of each type of insurance one can then decide which health insurance to take on. In most cases information disclosures, statements of accuracy, liability waivers and agreement to terms of service are involved before obtaining the health coverage.The time line of researching, completing and processing insurance application paperwork may take somewhere between a week and a few weeks.

Summary