You know the tiers — now pick your plan

Evaluate doctor reviews to help you choose your plan. Credit: Fuse
Evaluate doctor reviews to help you choose your plan.
Credit: Fuse

Every week, Archelle Georgiou, MD, Strategic Advisor at Healthgrades, will explain one facet of the Affordable Care Act.

If you are buying health insurance through an exchange, choosing the right health plan may feel like a daunting exercise. In the 36 states where the Department of Health and Human Services either fully or partially runs the Health Insurance Exchanges in 2014, consumers, on average, are able choose from eight different insurance companies and 53 different health plan options.

So where do you start?

First, narrow your options by selecting a health plan tier — Bronze, Silver, Gold or Platinum — based on your expected medical needs. A healthy 50-year-old who only anticipates needing preventive care, barring an accident or an unforeseen event, will probably spend the least by choosing an option in the Bronze or Silver tier with a lower monthly premium. However, a 50-year-old who expects to need a knee arthroscopy, an MRI, physical therapy and medications will likely incur less total cost by selecting a Gold or Platinum plan that has a higher premium but less financial responsibility for the surgery and its aftermath.

The next step goes beyond cost. Carefully evaluate each insurance option based on each plan’s network of providers. Plans offer access to different care providers, and the harsh reality is that the safety, complication and mortality rates of providers varies widely within a community.

Before you sign up for health insurance, be sure that you use objective outcome data to select the plan option that includes the providers you need and want to be available for your care. The quality of all hospitals and doctors is not equal.


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