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Compare Plans

Not all health plans are the same. The benefits, costs, and quality of care differ from plan to plan. Also, one health insurance company can offer different plans with different benefits and costs. For example, one plan may have a higher deductible (the amount you pay before the health plan starts to pay) than another plan.

Benefits

All health plans that the Department of Managed Health Care (DMHC) oversees must cover basic benefits. These include check-ups, routine tests, specialist care, and hospital and emergency care. You can see a list of these basic benefits. Other benefits, like prescription drugs and durable medical equipment (such as wheelchairs) may be covered by some plans and not by others. Your benefit package is all the benefits, or services, your health plan covers.

Costs

Costs differ from plan to plan. When you compare costs, look at the benefits as well as the costs. The plan that seems to cost less can really cost you more if it does not cover the services that you need.

Quality

The quality of care differs from plan to plan. The HMO Report Card can help you compare the quality of care for HMOs and medical groups in California.

Questions to Ask About a Health Plan

  • Can I keep the doctor I have now?
  • Can I get a doctor who speaks my language?
  • Which hospital will I have to use? Is it nearby?
  • Does the plan cover the services I need, such as prescription drugs?
  • How much will I have to pay each month? (This is the premium.)
  • How much will it cost to cover my dependents, such as my husband, wife or children?
  • How much will I have to pay each time I see a doctor or get a prescription? (This is the co-pay or co-insurance.)
  • Do I have to pay anything before the plan starts to pay? (This is the yearly deductible.)

Resources

California Office of the Patient Advocate
Report cards with information on California HMOs, PPOs and Medical Groups
1-866-466-8900 (many languages)
1-866-499-0858 (TTY)
www.opa.ca.gov

DMHC Plan Surveys and Summary Reports
Reports on health plan surveys conducted by the DMHC to make sure that health plans meet quality and medical standards
www.dmhc.ca.gov/library/reports/med_survey/med_default.aspx

HealthCare.gov
Information and on-line search tool to help consumers find health plans and public programs in each state
http://finder.healthcare.gov

National Committee for Quality Assurance
Information on quality health care and health plan standards
www.ncqa.org