3 Key Questions to Ask When Looking for Health Insurance

3 Key Questions to Ask When Looking for Health Insurance

Caring for your health is one of the most important things you’ll ever do, but no matter how healthy your lifestyle or how hard you try to avoid injuries, you will need medical attention at some point. This inevitability is why it’s so important to have a good health plan. Once you reach the age of 65, you’ll be eligible for Medicare benefits, and you may be eligible for Medicaid if you have disabilities, are low-income or meet other qualifications. In reality, though, neither of these is a total substitute for a proper health insurance plan.

The costs for healthcare in the United States can be enormous. That’s for emergency services, prescription medications from pharmacies, or even general checkups. Having to pay all of these costs out of pocket is a recipe for rapid financial ruin. You need an insurance company to help you bear the burden of these costs. While the Affordable Care Act has helped many families find better health coverage, there are still plenty of questions you should be asking when you look for health insurance on the marketplace. Here are just three of the biggest ones.

1. What are the true costs of the plan?

There’s a lot more to think about than the monthly premium when it comes to picking health care coverage. The first thing to consider is your deductible. This is the amount that you’ll be responsible for paying before your health insurance company starts covering costs, and it’s just part of your possible out-of-pocket expenses. For example, if you’re looking at a health care plan with a $5,000 deductible, you’ll have to pay that amount over the course of the year before your insurance starts covering the rest of your bills. Maybe you’ll spend all of your deductibles at once on emergency medical services, or maybe you’ll pay it out slowly over the year on medication.

You also want to pay attention to the copay information for your health plan. This is a flat fee that you’ll pay for doctor visits (even after you’ve paid off your deductible), and they may vary depending on the type of doctor you’re visiting. Ultimately, your health insurance plan will have a listed out-of-pocket maximum, which is the highest amount you’ll ever have to pay (including deductibles and co-payments) before your health insurer bears 100% of the remaining costs.

2. Will you be able to keep your current doctors?

Most health care plans have a covered network of doctors that you can see in order to get the best value out of the plan. If you decide to go out of network for general practitioners or specialists, you can expect to cover higher fees yourself. Before you commit to a new insurance plan, you need to get a list of doctors in the network, so you can decide if the plan is the best decision for you and your family.

On this note, you’ll also want to check to see what exclusions your new plan may have. Insurers used to be able to include exclusions for pre-existing conditions, but that was eliminated with the Affordable Care Act. Still, some insurance companies may have blanket statements regarding pandemics. Considering the recent COVID-19 pandemic, you may want to rethink any policy that will make it more difficult to receive treatment for such conditions.

3. What is the full coverage of the plan?

The Affordable Care Act stipulates ten essential benefits that all plans on the health insurance marketplace must carry, but these may not be enough to cover every situation for you or your family. Ask about any prescriptions you take to ensure that they’re covered. You may find that they’ll cost significantly more under one health plan compared to another.

If you or your spouse wear glasses or have dental work, then you’ll need to get additional coverage for dental and vision as well. You’ll have pediatric coverage with any plan on the marketplace, but adult coverage for these services and medical devices doesn’t come standard.



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