The Agency for Healthcare Research and Quality's (AHRQ) mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. Information from AHRQ's research helps people make more informed decisions and improve the quality of health care services. AHRQ was formerly known as the Agency for Health Care Policy and Research.
AHRQ is home to research centers that specialize in major areas of health care research:
- Quality improvement and patient safety.
- Outcomes and effectiveness of care.
- Clinical practice and technology assessment.
- Health care organization and delivery systems.
- Primary care (including preventive services).
- Health care costs and sources of payment.
Open Enrollment: What To Consider When Choosing a Health Plan
AHRQ Director Carolyn Clancy, M.D., has prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They will address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan. Check back regularly for new columns.
Excerpt:
It's open enrollment season, the time when millions of workers will choose the health insurance plan they'll have next year. With premiums for health coverage offered by employers rising, it may feel more like open season on your wallet. That's all the more reason you should understand your options.
To get the best value from your health plan, you need to understand your different coverage options and how they work. Then you need to make a choice that's based on your personal situation, such as whether you are single or married or have a chronic health condition.
Many of the common health insurance plans today offer several choices for coverage, based on factors including cost, flexibility and how much of a role you want to play in managing and paying for your own health care. These include:
- Preferred provider organizations (PPOs). These plans contract with doctors, hospitals, and other providers but typically do not manage your care. PPOs allow you to see providers outside the network, but you will pay more for your care if you do. These are the most common work-based health plans.
- Health maintenance organizations (HMOs). Many of these plans focus on preventing diseases and staying healthy. If you join an HMO, you typically must receive all your care from network providers, except in medical emergencies. When you join, you pick a primary care doctor to manage your care. HMOs usually have copayments rather than deductibles or co-insurance.
- Point-of-service organizations (POS). These plans are a combination of a PPO and an HMO. POS plans have a primary care doctor who manages your care but allow you to seek care from doctors and hospitals that are not part of the plan. You pay more for seeking care out of network, however.
- Consumer-directed health plans. These newer health
plans give you more control over your own health care, both
in choosing the care you receive and paying for it. They often require
you to pay a substantial deductible (often $2,000 or more) before
coverage starts, and are combined with a personal health savings
account or another similar product that allows you to pay for care
with pre-tax money.
RESOURCE: Agency for Healthcare Research