Central Maine Medical Center
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300 Main Street, Lewiston, ME 04240 | 207-795-0111

Choosing a Health Plan

Choosing the right health plan is important. It can also be challenging. Today there are more choices and more kinds of health plans than ever before.

What Should I Know Before Choosing A Health Plan?

Coverage:

What services does the plan cover? What are the deductibles? Does it cover home care, chiropractic services, mental health services, or anything else that is particularly important to you?

Choice:

Is there a certain doctor you’d like to choose, either for routine care or specialty care? Do you have to choose a physician from among those specified? Do you have a primary care hospital? If you have different rules for “emergency care” and “urgent care” how do you define the difference between the two?

Convenience:

Does your plan cover physicians who are located near your home or office? What is the procedure if you choose a physician and then find that you do not like him/her?

Cost:

You will pay all or part of the premium directly or through payroll deduction, plus a visit fee, or co-payment, whenever you get care. If your coverage is through your employer, your benefits manager can tell you what your portion of the premium will be. If you are in a Medicare managed care plan, there may be no premium.

Other:
  • Are the deductibles one time only, or yearly?
  • Is the insurance provider financially stable?
  • Is the plan accredited by NCQA? The National Committee for Quality Assurance is a non-profit watchdog organization created to assess, measure and report on care provided by the nation’s managed care groups. Since 1991, NCQA accreditation surveyors--mainly doctors--have evaluated a health plan’s organization, structure and quality improvement processes to see whether the plan was capable of delivering high quality care and continually improving the care it provided?
  • How long has the company been in business?
  • What is the average turn-around time on claims?
Put It All Together:

Is the combination of cost, quality, coverage and access to your preferred physicians or specialists, acceptable?