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Questions To Ask About Your Health Insurance Policy
Before you enroll in a health insurance program, you should know exactly what you’re
getting. Your agent will give you a list of your benefits, called a “benefits summary.” But
reading a benefits summary can be like trying to read ancient Greek.
Don’t worry: your agent understands it. And they’ll answer your questions in plain
English. Here are a few questions you should ask about any plan you look at:
- What are the monthly premiums?
This is will be your monthly insurance bill — so you’ll want to know this beforehand
so you can work it into your monthly budget. Your premiums won’t be decided until the
insurance company completes the underwriting process, which is when they look at your
medical history. But your agent can give you a ballpark figure.
- What is the deductible?
Sometimes low premiums mean high deductibles. A high deductible might be just what you want — but
make sure you know how high. Otherwise, a trip to the hospital could leave you with a bigger
bill than you expected.
- What is the co-payment and coinsurance?
How much will it cost you out of your own pocket to see a doctor? That’s your co-payment.
And once you meet your deductible, what percentage of medical expenses will you be responsible
for? That’s your coinsurance.
- What is the yearly maximum? What is the lifetime maximum?
Most plans put a cap on how much they’ll pay out on a yearly and lifetime basis. Make
sure you know what the caps are before you enroll in a plan.
- How large is the network of providers?
In most plans, you save money by using a network of doctors, hospitals, and other care providers.
Make sure your plan’s network is large enough for you to have convenient access to healthcare.
And if you already have a doctor you like seeing, make sure they’re in the network of
whatever plan you choose.
- What does it cost to go outside of the network?
If you have to get care from a provider outside your plan’s network, what will it cost?
Most PPO plans will cover some of the cost. HMO
plans typically won’t cover any of
the cost if you go outside the network.
- Are prescription drugs covered? Which ones?
Not all plans cover prescription medication. This is especially important if there are medications
that you rely on. If your plan covers prescription drugs, which ones are included? Some plans’ coverage
is limited to their formulary — a list of drugs that the plan will pay for.
- Are extra services covered? How about dental and vision?
Don’t assume that every plan will include coverage for teeth and eye care. Many plans
don’t. If you need eye care, make a point of asking your agent about it. And everyone needs
dental care. It may be cheaper for you to buy an additional dental plan, rather than find a
single health plan that includes it.
- Will you need referrals from a primary care physician to see specialists?
In some plans — notably HMOs — you need a referral from your primary care physician
to see a specialist. For many people this isn’t a problem. But if you seek specialist
care regularly, you could find the process of getting constant referrals difficult.
Ready to learn more? It’s time to talk with an agent. We’ll match you with qualified
health insurance agents — for free. It’s fast, easy, and secure. Get
your free quotes now.
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