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Comparing Health Plans

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Selecting a health plan that is best for you and your family is a very important decision...and sometimes a challenging one. 

Ask each plan you are considering for a Summary of Benefits and Coverage (SBC). An SBC provides an overview of the plan. See an example of an SBC form... 

You also may want to ask for the Evidence of Coverage (EOC) or other plan documents for more details about the benefits, costs, and rules for getting services.

When deciding, it is important to look at all 3 of these factors:

  • Benefits
  • Costs
  • Quality

Compare benefits

Benefits are the services that health plans cover. Make sure the plan covers the doctor visits, prescription drugs, lab tests, and other services you need. Learn more about comparing benefits... 

You can also use this OPA worksheet to help evaluate which plans may work best for you.

Compare costs

It is important to know the plan's monthly premium cost. It is also very important to understand the other costs, such as co-payments, deductibles, and co-insurance.  Learn more about comparing costs...

Compare quality

Health care quality means getting the right care at the right time. Some health plans provide better quality care than others.

Visit our section on Quality Report Cards to compare how health plans perform. The online Report Cards include ratings on:

  • Care for chronic conditions, such as asthma and diabetes
  • Care for children, cancer, and mental health
  • Member experiences with getting care easily, communicating with doctors, and other topics

Other factors to consider

If you have a doctor or medical group that you like, find out if this provider is in the network of the new plan you are considering. You can ask the plan for a list of providers in its network. You can also ask your doctor if she accepts your new health insurance. 

 

Resources

OPA Quality Report Cards

How to Use Your Health Plan (PDF)

 

Related Topics

HMOs, PPOs & other kinds of plans

Know your benefits

Health care costs 

Health Plan Problems?

For HMOs  888-466-2219
For PPOs   800-927-4357

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