How to Choose a Health PlanThe recent passage of the Patient Protection and Affordable Care Act, often referred to as ObamaCare, has drastically transformed how American’s–those without employer-provided coverage­–look for and choose health care coverage.  While the ACA provides much easier access to transparent side-by-side plan comparisons that used to require countless hours of research, choosing an excellent plan that meets your needs can still feel overwhelming. Fortunately it doesn’t have to be that way.

Whether you’re looking for a quality plan for yourself, your family, a loved one, or are an employer looking to choose a plan for your employees, this guide will help you sort through your options. To determine if your health plan makes the cut or find one that does, follow these helpful guidelines.

  1. Look for an NCQA accredited health plan

The National Committee for Quality Assurance (NCQA) is a private non-profit organization that rigorously measures and analyzes the quality of care and service provided by health care providers. NCQA accredited plans undergo rigorous scrutiny in a wide range of areas of patient care and provides a reliable report card of plans and health insurance rankings on the quality of care offered.

Look for an accredited plan that has met or exceeded NCQA’s high standards by searching through their report card. Choosing a plan that has been closely evaluated by an independent third party can help ensure that you’ll receive the best quality coverage.

  1. Compare the strengths of health plans to each other

The ACA and the new healthcare marketplace have made it even easier than ever to compare plans side by side. Using with the NCQA report card, you can also compare the different strengths of each possible plan in a variety of areas. Here are several important categories to consider when searching for a quality health plan:

  • Access and Service – Getting access to the care you need, when you need it, is vitally important for a great health plan. You want to make sure that your chosen provider has plenty of exceptional primary care doctors and specialists to meet the demands of everyone on the plan. You shouldn’t have to wait long periods to get access to the care that you need and you should receive a high level of customer service at all points of contact from plan to provider.
  • Qualified Providers – It’s important to find out how other patients rate doctors and other health care providers in your plan to find exceptional coverage. You also want to check the credentials, training, and legal history of the providers on your plan.
  • Staying Healthy – Look for a plan that offers preventative health services, including testing and screenings, to make sure you stay your healthiest.
  • Getting Better – A quality plan should give their members access to the most current health services, including new medical procedures, drugs and devices. What lengths does your plan go to so that you get better and stay healthy?
  • Living with Illness – Whether you have an existing chronic condition or develop one in the future, you want a plan that offers excellent programs to help manage long-term conditions, including asthma, diabetes, and more.
  1. Match Your Needs To Your Plans Strengths

Just as no two people are exactly alike, each health care plan offers different strengths that are better for some patients than others. When comparing health plans, carefully consider what areas of care and service are most important to and what type of coverage you may need in the future.

Do you have a chronic health condition that requires on-going treatment? Will you need maternity care, mental health services, or prescription drug coverage? You want to look for the plan that offers the most comprehensive coverage in the areas that you think will be most relevant to you as far as you can anticipate.

  1. Consider Other Factors

There are a number of other variables to consider when choosing a health plan, which requires a little more research, though they are largely affected by your personal preferences and budget. Some of those considerations include:

  • Doctors and Hospital – Are the doctors and hospitals that you would prefer to see considered “in-network” by your plan? Are they located near where you live and work? Are these factors important to you?
  • Value ­– This component will largely be determined by your budget and how much you are willing and able to pay for health care costs. Find out how much you will need to pay for out-of-pocket costs such as copayments (doctor’s visits and prescriptions). What is the cost of the monthly premium? Is there a deductible?
  • Additional Benefits and Services – Consider how well the plan covers you and your family’s health needs, including current, anticipated and potential unexpected emergencies. Is prescription medicine required? Do they offer prenatal and maternity care? Do they cover additional services that you need or may need such as physical therapy, chiropractor visits, smoking cessation, disease management, etc.?


Don’t allow the complexity of the health care system deter you from finding a quality health plan for you and your family that meets all of your needs and preferences. Your chosen plan should enable you to get the care you need in a timely manner that most effectively protects or restores your health.

Choosing a high quality plan and an excellent doctor plays a major role in determining the level of care you’ll receive. Utilize these guidelines, including the NCQA report card to help you find the best possible care for you and your family.


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