Questions to ask when buying health insurance

Shopping for health insurance can be intimidating, especially if you’re not sure what to look for. Asking a few key questions can help make sure you find the plan that’s right for you.

The first thing that catches most people’s eye is the premium, and that’s definitely important. The premium is the amount you’ll be paying each month to keep your plan. But if the premium is the only thing you’re comparing, you could be setting yourself up for trouble.

If you’re not sure what a deductible or copayment is or what Marketplace metal tiers are, your first step should be to brush up a bit. Our story on common health insurance terms and what they mean is a great place to start.

Once you’re feeling more comfortable with the terminology, ask yourself what things matter most to you about your health care.

Network/plan types

  • Do you have specific doctors or hospitals you prefer? If so, you may want to consider a Preferred Provider Organization (PPO) plan. A PPO gives you freedom to choose where you get your care, although you typically pay less if you see health care providers that are in-network.
  • Is cost your primary concern? A Health Maintenance Organization (HMO) plan will usually have lower premiums but require you to see health care providers that are in its network.
  • Are you looking for an alternative to traditional individual coverage or a temporary safety net? Then a short-term health plan could be the perfect fit, especially if you’re a recent college graduate, between jobs, or waiting for Medicare or group health coverage to begin. Short-term plans tend to be flexible and less expensive, but note that they may not cover preexisting conditions.

Your total costs

  • What is your out-of-pocket maximum? In addition to your monthly premium, your health plan will require you to pay for a certain percentage of your care. These are called out-of-pocket costs, and each plan will have an upper limit you pay each year. Beyond that, your plan will pay for 100% of covered services.
  • What is your deductible? The deductible is the amount of money you pay each year to cover eligible medical expenses before your insurance policy starts paying.
  • Are there copayments? A copayment is a flat fee for certain medical expenses. For example, paying $35 each time you visit a doctor.
  • What about coinsurance? Coinsurance is a percentage you pay for certain services after you reach your deductible. For example, your health plan may pay 80%, leaving your responsible for the other 20%.

The specifics

You’ll want to know what is and what isn’t included in your plan. Is there prescription drug coverage? A dental plan? Is alternative medicine covered? Are preventive services covered at no additional cost?  

As you can see, there is an awful lot to consider as you shop for the right health plan. Remember that the cheapest option may not be the best value. You can find out more by reading our page on Getting the Most from Your Health Plan or checking out WPS health plans.

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