Choosing and Using a Health Plan

Contents

• Your Health Plan Affects Many Things
• What Are Your Choices?
• How to Make Decisions Based on Quality
• Rate Your Health Plan Choices
• Sources of Additional Information

Today there are more health plans to choose from than ever before. Not everyone has a choice. But if you do, this section can help you choose the plan that offers the best quality for you and your family.

The quality of health plans varies widely. In 1997, a study published by the National Committee for Quality Assurance (NCQA) showed differences in the ways managed care organizations provide access to care, keep people healthy, treat illness, deliver high-quality service, and satisfy patients. For example, studies show that treating heart attack patients with beta blocker drugs saves lives. The NCQA found that in some health plans, most heart attack patients got beta blockers. In other health plans, only one in three did.

Research shows that Americans say that quality is the most important thing they think about when choosing a health plan. But research also shows that few people understand their options well enough to make an informed choice.

Quick Check for Quality

Look for a plan that:

• Has been rated highly by its members on the things that are important to you.
• Does a good job of helping people stay well and get better.
• Is accredited, if that is important to you.
• Has the doctors and hospitals you want or need.
• Provides the benefits you need.
• Provides services where and when you need them.
• Meets your budget.

Your Health Plan Affects Many Things

• Who will care for you (doctors and other health care providers), and how much choice you will have.
• What kind of care you will receive (for example, which preventive services are covered?).
• Where you will receive your care (which hospitals, for example).
• When you will receive your care (will you receive it when you need it?).
• How you will be cared for (the quality of care you receive).
• How much you will pay.

What Are Your Choices?

The two major types of health plans are "fee-for-service" and "managed care." Managed care plans can go by many names:

• Health Maintenance Organization (HMO).
• Preferred Provider Organization (PPO).
• Individual Practice Association (IPA).
• Point of Service (POS) plan, to name a few.

But different groups do not always define these names the same way.

Do not be confused by whether the plan is a "fee-for-service" plan, or whether the plan is one of the many kinds of managed care plans. What you need to understand is not the plan's label, but the characteristics of the plan. Research shows that it is important to understand your options and how they affect your choice of providers and services, costs, and quality of care.