In most cases, selecting a health coverage plan today means a compromise between selecting a plan that covers the things we are most likely to need versus getting coverage against the things that can cause us the most financial harm. The diagram below provides you with a simplified overview of three primary expense categories. As you can see the statistical likelihood that a person will need small expense medical care is high while that of a hospitalization/surgery is quite low. However, the financial impact of a major medical problem can be huge as compared with a minor problem requiring only an office visit.

Make sure the plan you select gives you the financial protection for the coverage you are most concerned about and be prepared to handle what isn’t covered out of your pocket. As you may have read in the discussion of Cost, Coverage and Control (Click Here ), one should be made fully aware that the cost of a Health Care Plan comes in two parts:

1. What you pay for the health care plan in premiums; and

2. What remains for you to pay after you have had medical treatment covered by the plan (Out-of-Pocket expenses).

Making the assumption that the health care plan you choose will provide coverage for all your needs without incurring out-of-pocket expenses will likely lead to a major disappointment. It seldom works out that way. The cost of a plan can give you a good clue (the lower the Premium the higher your out-of-pocket expense is likely to be). If it sounds too good to be true, then it probably is so!

Hopefully, the preceding discussion and graphics also allowed you to realize:

1. The higher the premium the greater the control; and

2. The higher the premium the greater the coverage (lower out-of-pocket expenses).

With this understanding you are now in a better position to appreciate that setting an arbitrary monthly premium as your primary means to select a plan can prove to be quite shortsighted in terms of the control and coverage you may need. The problem comes into better view when you realize that the size of even a modest medical expense these days can be substantial. For example, a plan with a $1,000 Deductible and 30% co-Insurance may seem reasonable especially if the price is right, but if that plan does not have a low Maximum Out-of-Pocket provision or you discover that non-plan providers are paid at a much lower rate, you could end up with a very large financial obligation that will affect you for years to come. The time to consider your needs and determine a realistic budget is before you select a plan.

The graphic below attempts to lay the foundation for a discussion on how one can balance the tendency to select the most affordable plan against the potential inherent out-of-pocket expenses embedded in the coverage.

As a general rule, as one accumulates assets the financial impact of a major medical incidence becomes increasingly important and the concerns about paying modest amounts out of pocket are low. One can elect to save on monthly premium expense by selecting a high deductible plan that provides for minimal outpatient care or, in contrast, a young Family with limited assets and building a family may need a health care plan that provides for maternity and offers low costs for pediatric services, Rx Drugs, and diagnostic fees as children are frequent users of such services. It is a process of balancing the premium cost against how much financial risk you are willing to accept or pass off to the Health Care Coverage provider or insurance carrier.

The question comes down to which of the three illustrations creates the greatest degree of comfort for you and you family given that no prefect plan actually exists?

Obviously, as depicted in the above illustrations, it is a bit of a balancing act that each person must seek the balancing point that is best for their situation. This is not something you can go the Internet to find out or even ask an Agent. The Internet or an agent can only indicate which plan represents the best value when comparing plans. Only you know your financial situation and how big of a financial exposure you are willing to tolerate. Other factors discussions on this site such as Cost, Coverage and Control (Click Here ), How Does Type of Plan Affect Quality of Care? (Click Here), and [See HCD-CC].

Armed with this information you will be well prepared to for the following short list of how you can determine the best “value” plan for you and your family:

1. Make a list of care categories that you are most concerned about;

2. Discuss these issues with all members that will be affected by the choice of the plan;

3. Determine where along the scale of premium costs you feel most comfortable;

4. Seek the counsel of an experienced professional Licensed Certified Field Broker/Agent ( Click Here).