Compare Benefits and Providers

Helen’s primary care doctor changed medical groups and she could no longer see her cardiologist. She decided to look for a new plan that would allow her to keep both doctors.

Read Helen’s story.

All HMOs are required by law to offer many basic benefits. However, other benefits are optional. And your choice of doctors and hospitals can also influence your decision.

Use the worksheet to evaluate a plan's benefits and services .

Topics on this page

• Decide which provider choices are important to you
• Decide if you need an optional benefit
• Language services
• Disability services
• Things to watch out for

Decide which provider choices
are important to you

• Do you want to keep your doctor or your child’s doctor? Ask the plan if the doctor is in the plan.
• Do you want to see providers outside the network? You can do this in a PPO, but not in an HMO.
• Which hospital(s) will you go to?
• Can you get evening or weekend appointments?
• In an HMO, most doctors you see are in your primary care doctor's medical group. Which medical groups are in the plan? You can compare medical groups in health plans.

Decide if you need an optional benefit, such as coverage for

• Prescription drugs.
• Medical supplies (except diabetes supplies, which all plans must cover).
• Durable medical equipment, like wheelchairs or respirators. Some plans also limit how much they will pay for this equipment in one year.
• Alcohol and drug abuse treatment.
• Mental health care (except for serious mental health conditions, which all plans must cover).
• Do you want prenatal coverage? All group plans cover pregnancy care, but a plan you buy on your own may not.

Language services

• Group HMOs, especially Medi-Cal Managed Care plans and Medicare Advantage plans, often provide more language services than other plans. Learn more about language assistance and compare how HMOs rate on language services.

Disability services

• A health plan should help you find providers whose offices and equipment are accessible to you.
• Some plans do a better job of this than others. Ask the plan what it can do to help you find accessible providers.
• Learn more about disability access. You can use the worksheets on
  communication assistance and physical access to list your needs.
• If you have providers you like, ask what plans they take.

Things to watch out for

• If you want a certain doctor who is in the plan, make sure she is taking new patients.
• Ask if your choice of providers is limited by the medical group you choose.
• If you are getting insurance on your own, make sure it will cover any pre-existing condition you have.

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