Your Guide to Develop Your Personal/Family Plan
Healthcare consumers rarely think or plan about their healthcare. Consumers spend more time planning for a family vacation than they do healthcare. The Personal/Family Health Plan is a document that guides the healthcare consumer to develop an annual medical and financial plan. The plan is designed to start by asking the healthcare consumer to determine their “Healthcare Must Haves”. “Healthcare Must Haves” can be medical, financial and likely both. Once identified, “Healthcare Must Haves” plan items become the foundation of the health plan.
Healthcare medical and financial events, planned or not planned, can be devastating to an individual or family. At a minimum, your Personal/Family Health Plan can plan for expected healthcare events, such a new baby, surgical procedure to fix your hip, etc…. In addition, your Personal/Family Health Plan can take into account any chronic health conditions that currently exist and your age. The older you are, the likelihood exists you will have more medical problems.
Planning for your healthcare annually can be very daunting. As the healthcare landscape changes, this process will become very important. Today’s healthcare consumer has been delegated the responsibility to manage their healthcare. The goal is to help the consumer with a practical approach to plan for their healthcare. The following steps will start the process.
Step I: Basic Healthcare Questions
The first step is to determine you and your families current health status. Current health status is based on previous health conditions, any current chronic conditions, your age and any other medical condition that exists. For those healthcare consumers that have children, in addition to the above, add any pediatric care needed if appropriate. This section is very subjective. The healthcare consumer should be as honest as possible to determine their health risk. If the healthcare consumer makes a mistake, the mistake should be aggressive versus conservative.
The following is a guide/checklist to assist the healthcare consumer:
|Basic Health Planning Factors||Answers|
|Family; Wife, Number of Children|
The above is clearly just a snap shot for health risk factors. By typing into your web browser “Personal Health Risk Factors” a number of web sites are available to help you understand your health risk more in depth. One site that we recommend is healthfinder. healthfinder is a powerful consumer tool for planning and managing your healthcare “Must Haves”. Below, we have included a brief definition of healthfinder, its content and two links. Again, we encourage you to utilize the tool.
healthfinder.gov is a prevention and wellness resource for consumers and their families — with evidence-based health information that’s actionable and easy to use.
healthfinder offers original content and helpful resources, including:
- myhealthfinder, a tool to get personalized recommendations for clinical preventive services
- More than 100 prevention and wellness topics
- Interactive quizzes and tools
- A calendar of National Health Observances
- Tool kits for professionals
- Links to resources from approximately 1,400 government and non-profit organizations that meet healthfinder’s Quality Guidelines
healthfinder.gov has won numerous awards, including the ClearMark award for best plain language public sector website and the Web Health Award for healthfinder.gov/espanol.
Below, two links have been established for the consumer to access to assist with your Personal/Family Healthcare planning process.
We have added a link to another web site My Healthfinder.
In addition, we have added a link to another web site Health Topics Quiz.
Step II: Determining your “Healthcare Must Haves”
“Healthcare Must Haves” are the foundation for your annual Personal/Family Health Plan. “Healthcare Must Haves” are defined in two general categories; Medical and Financial. The following guide will start with the basics.
|Are you planning a family?|
|Are planning any elective surgeries?|
|Do have a chronic/reoccurring medical condition?|
If you have answered yes to any of the above, start to plan for these medical events. Planning starts with reviewing your current health insurance plan to determine the coverage. If you are in a new health insurance selection period, review all plans available to determine coverage compared to monthly premiums. Out of pocket expense is a very big consideration. Make sure you understand your financial responsibilities. Step III will help with this process
|Are all healthcare providers in network; PCP, etc…?|
|Can you afford the annual out of pocket expense?|
|Can you afford the monthly premiums?|
Financial consideration are based on your current health insurance plan or the health insurance plan you have selected. Step III will help with this process
STEP III: SELECTING YOUR HEALTH INSURANCE PLAN
Selecting the correct health insurance plan is dependent upon what are your “Healthcare Must Haves” for the year. Remember, most employers ask employees to select a new health insurance plan annually. Depending on your circumstances, you may select a “Richer” plan one year to leverage coverage and minimize expanse and a “Less Rich” the next year to leverage health maintenance coverage and reduce expenses. Create a guide as shown below and populate with the appropriate information you need to make your healthcare decisions.
- List the “Healthcare Must Haves”…if appropriate create another guide showing out of network costs
- Based on the coverage benefits for each plan, populate the out of pocket costs you will be required to pay
- List Preventive Services covered at 100%…no out of pocket costs
- Enter the monthly premium
|Healthcare Must Haves; In Network||Ins Plan 1||Ins Plan 2||Ins Plan 3|
|Primary Care Doctor||$10 Co Pay||$15 Co Pay||$20 Ca Pay|
|Specialty Care Doctor||$30 Co Pay||$40 Co Pay||$50 Co Pay|
|Deducible per year||$1,000||$5,000||$10,000|
|In Patient out of Pockets||$200 per day||$300 per day||$500 per day|
|Out Patient Out of Pockets||$250||$1,000||$2,5000|
|Out Patient Surgery Out of Pockets||$300||$500||$750|
|Prescriptions Tiers: 1/2/3 Co pays||$5/$15/$50||$15/$30/$75||$25/$50/$100|
|Chronic condition costs; Therapy, etc…|
|Other: Specific Surgery|
|Other: Preventive Services||Annual Physical||Annual Physical||Annual Physical|
|Monthly Premium: Single/Family||$400/$1,200||$300/$1,000||$200/$800|
There are many different health insurance plans and selecting the correct insurance plan is very important. In the Consumer Information Navigator Section of this Web Site, we have outlined the process and types of plans available.
Step IV: SELECTING A HEALTHCARE SPENDING (HSA) OR FLEX SPENDING ACCOUNT (FSA)
Informed consumers have several options to help them offset their out of pocket healthcare expense. Selecting the correct health benefit can be confusing and requires the consumer to understand the differences before making a decision. Employers who offer health insurance allow them to set up either a FSA or a HSA to cover “qualified expenses” to include deductibles, co pays, co-insurance and prescriptions expenses. Some employers will either contribute monies or match employee contributions to FSA or HSA. Both health benefits have tax benefits, although they are not the same.
In the Consumer Information Navigator Section of this Web Site, we have outlined the process and types of plans available.
Step V: SELECTING YOUR HEALTHCARE PROVIDERS
Selecting your healthcare providers is a very important because they along with you manage your healthcare.
In the Consumer Information Navigator Section of this Web Site, we have outlined the process.
Step VI: YOUR HEALTH PLAN BUDGET
Budgeting for healthcare expense is a new process for the healthcare consumer to understand and complete. This process is becoming more critical since the management of healthcare and associated costs have shifted to the consumer. The following is a guide to assist the healthcare consumer in the budgeting process.
ANNUAL HEALTHCARE BUDGET TEMPLATE
|Healthcare Expenses||Computation||Projected Annual Costs|
|Monthly Insurance Premiums||12 months/monthly premium|
|Projected Annual PCP Visits||Visits/Co pays per visit|
|Projected Annual Specialty Visits||Visits/Co pays per visit|
|Projected Chronic Visits||Visits/Co pay per visit|
|Projected Annual Prescriptions||Co pays per Prescription/Number of Rxs|
|Elective Surgeries||Out of Pocket|
|Emergency Medical Expenses||Best Estimate|
By now, you clearly have an idea on how complex healthcare planning is and how important it is to you and your family. This process should be an annual event. The first year is the worst because of the learning curve. Subsequent years will be easier.