HC411R - If You Have No Choice of Plan

Debra: This is Healthcare 411. If your employer offers only one health insurance plan, what do you need to know?  More after this.

[PSA]

Man:     Okay, here’s your ham on rye, extra mayo.

Woman: Ahh, I ordered the turkey on whole wheat with mustard!

Announcer: Messing up your sandwich order is one thing, but messing up your medical care is another. Medical errors are one of the nation’s leading causes of death and injury. You can help avoid errors by being more involved in your health care. Get the fact sheet 20 Tips to Prevent Medical Errors by visiting AHRQ.gov/consumer.

A message from the U.S. Agency for Healthcare Research and Quality.

[End PSA]

Debra: This is Healthcare 411.  Every year many employers hold an open season during which employees can change their health plan or choose a new one.  But what if your employer offers only one health plan, or if you’re self-employed?  AHRQ Director Dr. Carolyn Clancy...

Dr. Clancy: Even if you don’t have a choice of health plans, you need to know what your plan covers, the fine print.  If you’re employed, you can talk to your employee benefits manager.  If you’re self-employed, you need to go to the insurance company or an agent for information.  It takes some homework, sometimes a lot of homework, but it’s worth it.

Debra: You need to ask a lot of questions.

Dr. Clancy: The basics are consistent.  You need to know what types of doctors’ visits, surgery or hospital services are included in the plan.  You need to know does the plan include prescription drugs or visits to the dentist or eye doctor?  And, of course, you need to know how much you’re going to pay out of pocket, if there is a co-pay or deductible you need to meet, or if there’s an overall limit or cap on benefits. 

Debra: And some health plans have rules about which doctors you can see and where you can be hospitalized.

Dr. Clancy:  The bottom line is it’s important to know how the plan works.  Don’t wait until you need health care to ask those important questions.

Debra: Get a free guide called Questions and Answers About Health Insurance by going to www.AHRQ.gov/consumer. I’m Debra James. Healthcare 411 is produced by the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.