Think You Have a Bad Health Care Plan? Here’s the Proof


NEW YORK (MainStreet) — Americans are spending more on health care insurance – but are they spending that money wisely?

According to a report from Towers Watson, both employers and employees are spending more for health care, seeing a 5.9% and 9.3% hike in health insurance costs, respectively, from 2011 to this year.

Out of pocket cost are expected to rise between 16% and 18% as well.

With all that cash on the table, how can consumers be sure they are getting good value for their health insurance dollar?

GoHealthInsurance, a Chicago-based online health insurance exchange firm, offers up some good benchmarks for consumers to use in evaluating the quality of their health care plans.

Specifically the firm has five solid signs that show you may have the wrong plan:

You don’t reach the plan’s deductible. GHI says if you never reach your health care plan’s deductible, you’re getting a raw deal. Better to match a high-deductible plan with a health care savings account to help with out-of-pocket costs.

You skip medical care to avoid a co-pay. This one is a big no-no. If you’re skipping out on doctor appointments to sidestep a co-pay, you have a bad health care plan. GHI offers two options – either get a plan with a lower co-payment or visit a local “minute clinic” for health care with a lower price tag.

Your doctor isn’t included in your plan. If your primary care physician doesn’t belong to your plan’s provider network, that’s an obstacle. That bumps up the cost of visiting your out-of-network provider while potentially forcing you to choose another, perhaps less suitable medical professional.

You don’t have a preferred-provider option. GHI says if you don’t have access to a preferred provider if you’re traveling, you’re tempting fate. In general, a PPO covers you no matter where you need medical help in the U.S.

You’re still paying for preventive care services. Most health care plans don’t charge you for preventive heath care visits, largely due to the Affordable Care Act. If your plan was locked in before March 23, 2010, you might still be paying for preventive services you don’t have to.

There are some hard and fast rules that apply to quality health care coverage, and most start with the red flags listed above.

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