An Rx for picking a health plan

Here are some points to consider when making a decision about health care coverage:

By Times staff

© St. Petersburg Times,
published November 6, 2001

Don't follow your doctor, follow the plan.

Whether we can keep our physician is the first thing many of us ask when switching coverage. But plans drop doctors and doctors drop plans, so there is no guarantee you'll keep yours. Go for the best overall package, some experts advise.

The directory of providers could be out of date. Call to verify.

Listings provided by health plans of approved doctors, dentists and specialists may not reflect recent departures or additions. Phone the doctor to check. And if you intend to pick a new doctor from the list, phone first: Some may not be taking new patients.

If you have a chronic condition, choose a plan that continues your treatment.

If you're dealing with an ongoing illness -- kidney disease, heart problems, diabetes or others -- you may not want to switch specialists and outpatient services even if it would save some money.

Beware the fine print on prescription coverage.

A person who runs to the pharmacy for an occasional sore throat won't feel the pinch, but anyone on "maintenance" drugs (blood pressure pills, for example) needs to carefully review options: Will I need to buy in bulk? By mail? Generic? Formulary? How many refills without a doctor's visit? How much will I pay? Must I drive cross-county to the only member pharmacy?

Consider your history and make odds on the future.

Should a man who has lost a father and brother to heart attacks go for a Cadillac plan with improved access to specialists? How about a woman who has survived breast cancer? More than half of all health plans do not include maternity coverage: What if you want to have children?

Quit stalling.

The packet of paperwork is daunting, so the temptation is to set it aside until the night before. Like doing taxes, picking a health care plan is complicated. Leave enough time to ask questions, phone doctors and compare notes with co-workers. You should spend at least as much time as it took to pick a calling plan for your cell phone.

Get used to doing it yourself.

Every trend in health insurance is toward more responsibility on the individual: to research, to pick and choose benefits cafeteria-style, to self-limit use so costs can be contained. Anyone else have a headache?

SOURCES: Hewitt Associates; Morton Plant Mease Health Care; Florida Insurance Brokers; Times wires.

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