Has shopping for health insurance left you confused and frustrated? Don’t worry, we’ve got you. Shopping for health insurance can feel about as easy as getting home during rush hour traffic, but understanding your options and how to choose plans is important. To help we’ve put together a list of questions for you to ask while choosing a plan. These questions can help you sift through the various plan details and help you decide which ones are best for you, your family, your health, and your budget. Think of it as your health insurance cheat sheet.
With these questions in your pocket, you’ll be able to confidently compare health plans. Whether you’re selecting a plan for the first time, or if you’re thinking about changing your current plan, these questions are important to keep in mind.
How Much Does the Plan Cost?
You’ll want to carefully look over plan prices, not just the premium, you’ll want to know how much the other out-of-pocket costs will be as well. Premiums, deductibles, copays and other costs of health insurance all vary from plan to plan and state to state. So, comparing is key here to make sure you get a plan that fits within your budget. We’ve gone into a little more detail about each of the costs you’ll want to research below.
Your Premium
This is the monthly fee you pay for your insurance company to provide you and your family with coverage. The cost of your premium will vary depending on a few factors. First, the majority of insurance companies will underwrite you before they insure you. Meaning they will collect all of your health data and use them to determine your “risk factor”. Other variables include your age, your lifestyle, and sometimes even where you live.
Your Deductible
Before your plan will cover your medical expenses, you have to first meet your deductible. For example, say your plan carries a $1,500 deductible and you need a surgery that costs $3,500. You will have to pay $1,500 and then your company should cover the remaining $2,000. Keep in mind, your premium will not count towards your deductible. The things that will count towards it are any bills you pay for hospital stays, surgeries, lab tests, anesthesia, doctor visits that aren’t covered with a copay, and medical devices such as pacemakers.
Your Copay or Coinsurance
When you visit the doctor or fill a prescription, you’ll pay a copay upfront. It’s a flat fee, typically between $10-$30. Each part of your health services may have different copays such as $30 per doctor visit or $20 per prescription, but each of those services will always have that same copay. For instance, if you injure your back and visit the doctor, or if your child’s asthma medication needs to be refilled, the copay amount – for that visit or medication will remain the same.
Coinsurance is the portion of medical expenses you are responsible for after your deductible has been met. Coinsurance is a way of saying that you and your insurance company each pay a portion of the eligible costs that total 100%. For instance, if your coinsurance is 20%, you are responsible for 20% of the cost of your covered medical expenses. Your health insurance will cover the remaining 80 percent.
What Kind Of Coverage Do I Need?
After deciding your budget, the next question is about coverage. Do you have health conditions? Do you know you see the doctor often? Are you healthy? There’s a large variety of plans that will give you more coverage if you aren’t healthy, or less coverage if you are healthy. That way you don’t pay for coverage you don’t need, and you know the things you do need will be taken care of.
Health Maintenance Organizations (HMOs) provide access to doctors within their network, whereas Preferred Provider Organizations (PPOs) provide access to a larger network at a higher cost. There are also 4 plan tiers available: Bronze, Silver, Gold, and Platinum. Each tier has varying prices with varying coverage. If you want a low monthly premium and are healthy, a Bronze or Silver plan is your best option. While Gold and Platinum plans have higher premiums but lower deductibles. Making them ideal for anyone with medical conditions that need more care.
Is My Current Doctor In The Plan’s Network?
One of the most common concerns while searching for health insurance is whether or not you can keep seeing the doctors you already have. If you have ongoing medical conditions, or simply just like your current doctor, the last thing you want to have to do is switch doctors. It means having to explain your entire medical history and probably retake tests you’ve already had done. It can also bring up an issue if your new doctor doesn’t agree with your old doctor’s diagnosis or treatments. Your doctor is definitely one of those situations where familiarity is important. When you’re shopping for health insurance, find out what the plan’s network looks like. The network isn’t just primary doctors either, it’s also hospitals, facilities, and specialists as well. You don’t want to find out too late that the hospital closest to you doesn’t accept your insurance.
Are There Extra Benefits or Perks?
This may seem small, but it can be the selling point between one plan over another. Some plans will offer things like dental and vision discounts, telehealth, gym memberships, etc. You’ll want to decide if you want the bells and whistles or if you don’t really care for them. These perks can be offered as “free”, but keep in mind the more benefits a plan has the more expensive your plan is likely to be.
Will My Plan Travel with Me?
If you travel frequently, whether for work or leisure, you should make sure your plan has the freedom and flexibility you’ll need, regardless of where you are when you need it. You’ll want to look at the network again, and the budget. Will you pay more for out-of-network facilities and doctors? If you do pay more, can you be reimbursed? If it’s Christmas and you’re four states away visiting family and you need the emergency room the last thing you want to do is worry about a giant medical bill.
Is My Medication Covered?
Two-thirds of adults in the U.S. use prescription medications, so there’s a good chance you will too, if you don’t already. It’s not uncommon for you to get caught up in the other details of your health plan and forget to look at the prescription drug coverage. These costs can rack up quickly, so be sure to look at the plan’s drug formulary before you enroll. The formulary is a list of prescription drugs that are covered as well as their associated costs. That way you can better budget for any medications you currently take, as well as any antibiotics you might need in the future.
Will This Plan Cover Alternative Therapies?
If you’re interested in alternative therapies (alternative medicine) you’ll want to make sure those will be covered as well. Some alternative medicine would be a chiropractor, having a home birth, or getting acupuncture. Different health plans handle these types of services differently. In some circumstances they can be covered similarly to your other health care. On the other hand, some plans might have minimal or no coverage for alternative therapies. If this type of care is important to you, make sure to look closely at the plan’s benefits in detail.
Who Can I Call With Questions?
Most people agree that, when it comes to health insurance companies, the worst part is the lengthy phone calls. There is typically a customer service line, but you’ll most likely deal with a lot of transfers or possibly be placed on hold for long periods of time. Some have direct numbers for agents to speak to you directly or chat services where you can virtually ask your questions. Most will even have a discussion forum where you can find the answers to some of your questions. The worst systems are the automated phone systems, where you have to listen to several menus and hope what you need is on the list. There’s a way to avoid all of that hassle and uncertainty though: giving one of EZs agents a call.
EZ.Insure provides highly trained agents in your region who can answer all of the above questions and then some. You get to speak with a real person, -skip the automated line, and get all of -the information quickly. The best part? It’s free! We will assign you to your own personal agent who will search and compare all available plans in your area at no – cost. We make sure to find you plans that fit within your budget without sacrificing coverage needs. To get your instant free quotes today simply enter your zip code in the box below or give us a call at 877-670-3557 to speak to an agent directly.
With over a decade of helpful content experience Cassandra has dedicated her career to making sure people have access to relevant, easy to understand, and valuable information. After realizing a huge knowledge gap Cassandra spent years researching and working with health insurance companies to create accessible guides and articles to walk anyone through every aspect of the insurance process.
