• Lesson Plan
  • Lesson 1: Introduction to Health Insurance
  • Lesson 2: The Costs of Your Policy
  • Lesson 3: Choosing the Right Health Plan
  • Lesson 4: Things to Watch Out For
  • Lesson 5: Balancing Cost and Coverage
  • Lesson 6: All About Health Savings Accounts
  • Lesson 7: Start Comparing Plans
  • Lesson 8: How to Evaluate Insurers
  • Lesson 9: Get the Best Care Possible
  • Lesson 10: Final Summary

Lesson 9: How to Get the Best Care for Your Premium Dollar

Today's discussion will be short and sweet. We just want to leave you with a few strategies for maximizing your health care dollar.

We're finished talking exclusively about insurance. We want to, instead, focus on putting the policy you choose to work for you to the fullest extent possible. It's a crucial final step in the process of securing a health plan that makes sense, particularly if your policy falls under the category of "managed care", which, for most Americans, is the case.

Specifically, we're going to look at evaluating the network and the organizational system of any plan you're considering. (Keep reading! It's not nearly so boring as it sounds!)


While this may seem like something you can afford to put off until after you've already chosen a plan (who needs to choose a doctor so early in the process?), it's not.

The way a specific plan or organization is structured can have very serious effects on your and your family's medical care. Let's take a look at how.

Questions for health plan administrators

With any plan, you need to start by examining the specifics of how your care will work. Here are the questions to ask:


Do you have to choose a primary care giver?

How easy is it to change physicians?

Will you always need a referral to see specialist?

How easy is it to switch specialists?

Can you use a specialist for your primary physician? (This may be important for patients who suffer from chronic illnesses.)

Will the plan cover your participation in a clinical trial, should the circumstance arise?

Is the plan affiliated with major medical centers in the area or nation? (This may come into play for access to many cutting-edge treatments.)

Is the plan open to covering new treatments and tests in general?

Who decides which new procedures will be covered? (It's generally a lot better for patients when doctors, rather than administrators, make such decisions.)



But your investigation shouldn't stop there. Other important questions are best answered by a physician within the network (Doctors are bound to answer some questions that insurers and administrators are not.)

Which means that you should really choose, or at least speak with, a physician before you sign onto a policy. A trusted doctor's perspective on how a particular health plan works is possible the most important point-of-view of all when it comes to securing quality care.

Here's what you need to ask any potential doctor:

Questions for your health plans doctors

How does your health care organization compensate its doctors - under a fee-for-service model, or through capitation? (Capitation rewards doctors for using fewer services, while fee-for-service does not. Such financial incentive could cause a doctor to cut corners.)

Are bonuses awarded for fewer specialist referrals? (Same issue.)

Will the doctor act as an advocate on your behalf against the organization if a plan fails to cover a specific treatment?



These are questions you need to keep asking throughout the life of your policy. Managed care does not mean substandard care, but it can mean fewer options available to you as a patient.

That is why the best way to make managed care work for you is to remain active in your care and by constantly ensuring that every possible medical option has been explored.

After all, it's your health!

Well, that's our course. We hope that you're nearer your goal of safe but affordable care. For more information on policy specifics, see our website. And don't forget to re-visit eHealthInsurance and NetQuote for quotes whenever the need arises.


One last thing, for the last time: there must be someone you know who could benefit from reading this course. Forward them this email, or simply send them this link: http://www.moneyindepth.com/health-insurance/health-insurance-course.html. They'll be grateful to you, we're sure of it.


P.S. Did you know that we have a course just like this one, specifically about auto insurance? You can learn to save as much as $600 off of your current premiums! (That'll help pay for that new HMO you're going to join). Easy last day.


Next: Lesson 10: summing it all up