How Do I Select A Health Plan For Me and My Family?

by Lourdes Rivera

As more people are enrolled in managed care plans through their private health insurance, Medicare, or Medicaid, it is important for consumers to obtain more information and to understand how managed care works. The primary manager of managed care should be the patient. We all must be ready to take a more active role in making health decisions and in advocating for the services that we think we need. Our goal is to help you work with your health care providers in obtaining and managing your own health care.

Starting with the May/June issue of The Network News, the National Women's Health Network is providing a series of articles to assist you to navigate managed care. In the last article we discussed "What is managed care?" In this issue, we will provide guidance on how to choose a managed care plan. There may be many health plans to choose from, so it is important to select the best one for you and your family. Before you sign up for a plan, use this checklist to begin gathering information. (If your employer and/or union representative has the responsibility to select and/or negotiate contract terms with managed care plans, give this list to him or her!) Decide which of the following questions are important for you, then check the box if the answer is yes. The more check marks you have the better the plan may be for you. (Make a xerox copy of this list in order to evaluate each potential health plan that you are considering.) For each question below, there are also follow-up questions that you may wish to ask, depending on your needs and interests.
 

Who to Talk to for Help in Selecting a Plan: Ask as many people as you can about the plan(s) you are considering.

Talk to...
your doctor, nurse, alternative practitioner, or other health provider your state or local medical society your boss your employer's or union's benefits counselor Medicare or Medicaid

Talk to...
Neighbors co-workers family and friends

Talk to...
the membership services offices (patient relations representative) of the health plans you might choose

Make notes of your conversations. Include the date you call and the names of the people with whom you speak.