Questions to Ask Before Buying Health Insurance
Medical care may be a necessity, but individuals do exert some freedom of choice in regards to health insurance. An individual may purchase an insurance policy on their own. This allows you to tailor your policy to your own specific needs. Since there are numerous healthcare providers available, this process entails careful research and comparison shopping.
Another option is purchasing insurance through your employer, union organization or professional association. Some advantages of group health insurance are cost (it is cheaper to purchase insurance as part of a bulk package and large employers usually pay a portion of the premium), eligibility (group plans typically do not require a medical exam or other evidence you are insurable) and portability (a federal COBRA provision requires you are able to maintain your coverage if you leave your job, providing you continue making your premium payments). Lastly, Medicaid is a state and federal program which provides healthcare to low income individuals that qualify. Special consideration is given to children, pregnant women and the disabled. Contact your state Medicaid office for details.
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It is important to keep a few key questions in mind when deciding to purchase a health insurance plan. Whether you are choosing between multiple group plans offered by your employer or selecting an individual insurance plan, asking your human resources department or insurance agent the following questions will provide you with a clearer understanding on the options available to you.
- Does the plan allow you to choose the specific doctor or hospital you want to use?
- If you need to see a specialist, how does the referral process work?
- Are there any exclusions (pre-existing medical/health conditions or circumstances that can make you ineligible for healthcare coverage)?
- What is the procedure for care if you are away from home?
- What is the plan’s premium (your monthly fee for coverage), deductible (the amount you must pay upfront before the policy begins to pay your medical expenses), and co-payment (a specific charge for a specific medical service or medication, such as a $10 fee for a doctor visit or a $5 fee for a prescription)?
- Are there out-of-network fees (a charge for seeing a doctor or hospital not affiliated with your plan) or other fees?
- Is there a maximum amount the plan will pay over a year? Over a lifetime?
- What benefits are specific to this plan? What services will not be covered (most plans do not cover every service, for instance, some may not cover mental health services or alternative therapies)?
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The final step in choosing a plan is to think about your specific circumstances, conditions and concerns. If you make frequent hospital visits/stays, it would make sense to choose a program which may have a higher monthly premium but has a less out-of-pocket fee schedule for visits. If you are healthy and only see the doctor occasionally, it would make more sense to seek out a plan with a lower monthly payment, even if the out-of-pocket fees are higher.
And don’t forget to check out the services each plan covers. Almost every plan will only cover “medically necessary” procedures and care. Once again, alternative therapies, mental health, chiropractic services and experimental therapies may not be covered. Plan administrators generally determine what is “medically necessary.” If you disagree with their definition, it is your responsibility to find a plan that covers the services you want and need. But don’t fret too much over the details, a year from now during your next enrollment period, you can change your mind and your plan. There is much choice and it remains with you.
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