Knowing how to choose the right health insurance can be a daunting task for anyone, but for those who must also consider special needs, this choice takes on greater responsibility. How do you know if an insurance plan will cover the services and doctors your family member with special needs will require?
You may want to choose a provider network that includes a top-tier research hospital (such as UW Health Hospitals & Clinics) and offers a variety of specialists and therapeutic approaches for your family member. Check whether the provider network has clinic locations with desired specialists near your home.
If referrals are required, you will need to visit your Primary Care doctor to get approved for your visit with a specialist. This involves extra time and cost. It may make sense to choose a health insurance plan that does not require referrals.
Make sure the health plan is highly rated by the National Committee for Quality Assurance (NCQA). NCQA uses three broad measures to rate health plans: consumer satisfaction with the plan, clinical quality and an assessment of the plan’s quality processes.
Some health insurance plans offer specialized workshops, personalized health coaching, health management programs and other support that helps both the care giver and the patient with special needs.
Because of the Affordable Care Act (ACA), ACA-compliant health plans offer subsidies that may help pay for certain health insurance costs. Not everyone qualifies for subsidies, but you can find out if you qualify here.
In addition, many communities throughout Wisconsin offer services for family members with special needs that can provide needed assistance. For example, the Aging & Disability Resource Center of Dane County (ADRC) is a great resource for people with special needs.
You can count on Quartz’s friendly and knowledgeable Customer Service representatives to help you find the plan that’s right for you.