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I need to choose a health-insurance plan.

ADVICE FROM: James Brown, director of health services, America's Health Insurance Resource Center.

HMO, PPO, POS, PHCS…they make my head spin. Do I need to know what these mean?
The people in charge of benefits at your company should go through all that. The basic idea is that with an HMO you have to go through a network of doctors and hospitals the insurer has contracted with, whereas in a PPO where you can go outside the network. The catch is that with PPOs you have to pay a deductible first and then a higher percentage cost of the care.

It's still hard to figure out. Is one better than the other?
I wouldn’t recommend an HMO, because you’re restricted to the doctors in that plan, though if all your doctors are offered in the HMO, it’s great. Also, if you go to a hospital in the HMO network, you’re covered by the premium you pay, so it’s not completely free but you don’t have to pay extra costs. By law, an HMO cannot limit your lifetime payout. Still, I recommend a plan where you have the most providers as opposed to one where you’re limited. It might cost you more but you’re better off.

How can I evaluate the specific plans my company offers?
A lot of employers only offer a single plan, and you'll usually want to just take it. However, the Department of Health for the state of New York rates different plans on its website, on such measures as quality of services provided and how complaints are resolved. It’s like the Better Business Bureau of health insurance.

What else should I be considering when I choose a plan?
The real problem people often have is knowing how to pick a doctor. It's difficult because people aren't educated enough about this, and usually they just go to friends for recommendations. But there are now resources online that tell whether or not a doctor has had malpractice suits, whether they’re board certified, what hospitals they have admitting privileges to and so forth. You can look that up at places like nydoctorprofile.com or healthgrades.com (stick to the free stuff). Though it’s still hard to tell whom you'll be comfortable with until you’ve been in their office and met them.

What are some questions I should ask ay my HR orientation?
You want to know how much your copayment will be when you go to the doctor, and you especially want to know your prescription drug plan. With the better plan you have a copay on certain drugs; with a not-as-good plan you pay a percentage of the cost of the drug, and that can be a lot of money—up to a few hundred dollars for a month's supply. Now, at stores like Wal-Mart or Target, you can get a month's supply of over 300 kinds of generic drugs for $4 a month, which might be less than what you pay with your plan.

Wow, that's a lot of dough. What else do people overlook?
You should ask about the mental health benefits. You want to know how many visits you can have for a therapist and so forth. Another thing most people forget to ask is what happens if you’re denied some type of coverage. You should know, will the employees’ benefit office assist you in a complaint against the insurer? What is the appeals process with that health plan?

Without getting personal, there are a lot of weird specialists I have to see. How would that affect my decision?
Many conditions that people have, there are organizations for them. For example, if you’re diabetic there’s the Diabetic Association. It’s a good thing to attach yourself to these groups because they’re very knowledgeable about providers and insurance for these illnesses.

I just left my job to work on my novel. How would I know if COBRA is a good idea for me?
There’s something called “COBRA sticker shock,” when people get their COBRA letter and find out how much it costs. Right now in New York, COBRA can run you $400 to $500 a month. That includes the full premium your employer paid plus a 2 percent administrative fee. You would only want to pay this if it’s the least expensive insurance you can get, or to use temporarily until you find a more affordable plan.

So what are some cheaper private insurance options?
If your income comes out less than $25,000 a year and you’re doing some sort of work, then you can get something called Healthy New York, which costs between $220 and $280 a month. It’s offered by all the HMOs in New York, and the insurance is subsidized by the state. By contrast, to purchase a plan directly from insurers would cost you $600–$900 a month.

The New York City hospitals have a program called Health and Hospital Corporation (HHC) Options. This consists of city hospitals (such as Bellevue in Manhattan, Jacobi Medical Center in the Bronx and Elmhurst in Brooklyn) charging on a sliding scale based on your income level. You can apply for an HHC card at any of these locations.

My employer has a waiting period before I'm enrolled in their plan, but I've already left my other job where I was covered before. How do I handle that transition window?
That’s also when you want COBRA. It exists to get people from one plan to another.

Honestly, is there any way my employer will ever know what I'm seeing these doctors about? That freaks me out.
They shouldn’t. You’re protected by confidentiality laws established in the Health Insurance Portability and Accountability Act (HIPAA). You can also not be fired because you’re using too much insurance.

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