Health Insurance is complicated.
Here at HealthInsuance-Resources.com our mission is to help you find the right coverage for you and your family.
Here’s some questions you need to ask any health insurance company, and the agents representing them.
1. What Type of Plan Is This?
If you’ve ever called a doctor’s office to find out if they accept your insurance, there are two questions they usually ask. Who’s your carrier and what type of plan is it? The first answer should be easy. The second, not so much.
Often, you’ll find yourself in possession of a managed care system. This means either a health maintenance organization (HMO) or a preferred provider organization (PPO) will cover a certain amount of your expenses.
In an HMO, you can only visit doctors who are under contract with them. In a PPO, you can visit doctors outside their network, but you’ll pay more for it. If you visit one of their doctors, you’ll enjoy a nice discount.
2. Is My Current Provider Included In Your Plan?
Once you’re fully enrolled and have access to your online portal, you’ll be able to search for primary care physicians, specialists, and more. Until you reach that stage of the game, it’s worth asking your health insurance agent if any of your current doctors are covered under the plan you’re considering.
We all know that, once we find a nice doctor we’re comfortable with, it’s hard to let them go. Knowing that you won’t have to start all over again somewhere else, transfer your medical records, and get reacclimatized is a pleasant reassurance.
And don’t forget, if you’re considering a PPO, keeping your doctor isn’t outside the realm of possibility. It just may cost you a little bit more money out-of-pocket.
That said, if your current provider is a must-have, and you want your visits to be fully covered, take some time to compare life insurance quotes. Seeing the full spectrum of options will only benefit you in the long run.
3. What Will My Monthly Premiums Be?
Let’s do a little budgeting here. In a typical monthly budget, we have to consider rent/mortgage, utilities, food, transportation costs, debt repayment, savings, and a little wiggle room for entertainment. And that’s just scratching the surface.
What can you afford in terms of monthly health insurance premiums? Often, as monthly premiums shift up and down the scale, so does your deductible.
Here’s an example from the Blue Cross Blue Shield health care insurance plan. They point out that the higher a plan’s deductible is, the lower the premium will be. Conversely, the lower the deductible, the higher the premium. Be sure to ask your health insurance agent about this.
4. What’s My Deductible?
Which brings us to one of the most popular terms in a health insurance agent’s life, the deductible. Basically, your deductible is how much you have to pay out-of-pocket before your health insurance kicks in and starts to cover your costs.
Often, preventative care is free. This tends to include shots or pre-screening tests. If you’ve ever enrolled in the Health Insurance Marketplace, you may have noticed certain preventative services were covered, regardless of your deductible.
For the Health Insurance Marketplace, substance abuse counseling, depression screening, immunization vaccines, aspirin to prevent cardiovascular disease, and more are covered.
So, these are all things to consider as you weigh paying more or less each month, based on your plan’s deductible.
5. What’s My Copayment?
Your copayment may come up in your discussion about your deductible. But, be sure to get a clear answer from your health insurance agent about it. Will it vary by provider? Should you expect a small flat fee in the vicinity of, say, $10?
Generally, your copayments don’t count toward your deductible. So, this is another cost to factor into your budget. You’d still have to meet your deductible based on any treatments you may receive. But, certainly, this is a helpful topic to cover with your health insurance agent.
6. What Are My Restrictions on Pre-Existing Conditions?
If you or someone in your family has a pre-existing condition, the policy you’re considering may not cover your medical costs for a period of time. It’s important to find out how long pre-existing conditions are excluded.
Let’s take the Health Insurance Marketplace as an example again. They cover pre-existing conditions and state that no insurance plan can reject you or charge you more for a condition you had prior to the start of your coverage.
For this reason, it’s helpful to have an abundance of medical records. This will remove any shadow of doubt over the validity of your pre-existing condition.