Top 10 questions to ask when picking a health plan

You want a plan that fits your budget – but there’s more to ask than “How much?” When you’re comparing the nitty gritty, add these questions to your list.

How much will it cost me, and what happens if I get sick or hurt? Those questions are at the top of many people’s minds as they look at health plan options. Sure, it’s important to have a plan that fits your budget and has your back – but when you’re comparing the nitty gritty, consider adding these 10 questions to your list.

10 questions to ask when you choose your health plan:

#10: What's my best-cost scenario?

Let’s say next year is just like the past five. You go to the doctor about three times for routine exams and a cold or two. Your husband is healthy as a horse, as long as he swallows his little cholesterol pill every day. And your kids, well, let’s just say they average a cast and 11 stitches a year.

Ask the insurance company:

  • How much do I pay each month (premium)?
  • How much do I pay for the year before the plan starts to help (deductible)?
  • How much do I pay to go to the doctor, urgent care and the emergency room, and to get prescriptions (copays)?
  • What is my share of the cost of other care, like getting an X-ray or staying in the hospital (coinsurance)?

Ask yourself:

  • Under a new plan, what would it cost to get this same care as last year – no major illnesses or accidents, no new diagnoses or treatment needs?
  • Does the bottom line fit my budget?

#9 What's my worst-cost scenario?

OK, what if you have a lot more casts or stitches next year? Or if, unfortunately, you or a family member suffers a major illness or accident that leads to a hospital stay, lots of doctor visits, new prescriptions and continued care, how bad would it be? Every plan has a top amount you’d have to pay for your care in a year. It’s called the “out-of-pocket maximum,” and once you pay that much, your plan will pay for 100 percent of everything else it covers for the year.

Ask the insurance company:

  • What’s the most I’d have to pay for care next year (out-of-pocket maximum)?

Ask yourself:

  • Could I afford to pay it if I had to?

#8 What's up [with my] doc?

Health insurance companies work with different doctors and clinics to get the best deals on your care. Getting care from a person or place your plan covers saves you the most money. Getting care somewhere else means your health plan will pay for much less – if any – of your care, leaving you with bigger bills.

Ask the insurance company:

  • Is my current doctor covered by this plan?
  • How much will I pay if I see a doctor who isn’t covered?

Ask yourself:

  • Are you willing to switch doctors if yours isn’t covered?

#7 What about my medicine cabinet?

Make sure it gets stocked with what you need, when you need it, in a way that works for you. A plan’s preferred drug list, or formulary, shows which drugs are covered and how much they’ll cost you.

Ask the insurance company:

  • How much will I pay for my regular prescriptions?
  • What are my options if they’re not covered?
  • Which pharmacies can I use?
  • Do you have to approve any prescriptions before I fill them?

Ask yourself:

  • Can you afford the costs for your regular prescriptions?
  • Are pharmacy hours and locations convenient?

#6 What if I'm sick?

The moment you just know you have a sinus infection is not the moment you want to figure out who you call, where you go and how fast you can get things flowing again. Ask health insurance companies how their process works.

Ask the insurance company:

  • Do I have to pick one clinic or doctor that I always go to first?
  • Can I walk in or get an appointment the same day I call?
  • Do you have a virtual clinic where I can talk to a doctor online?

Ask yourself:

  • Does the process work well for your family?

#5 What if I'm well?

Because the only thing better than things going smoothly when you’re sick is staying healthy in the first place. Compare what plans do to keep you feeling your best.

Ask the insurance company:

  • What free services to you provide to keep me healthy?
  • Do I pay anything for checkups, annual OB visits and regular screenings?
  • Do I pay anything for regular immunizations like flu shots?

Ask yourself:

  • Which services are important to you?
  • Can you afford what they’ll cost?

#4 What are the alternatives?

If you have your chiropractor on speed dial, long to have your baby at a birth center or are curious about acupuncture, check out plan options. Some cover alternative therapies, practitioners and facilities, some help out with the cost a little bit and with some, you’re on your own. Make sure a plan covers what’s important to you.

Ask the insurance company:

  • How much do I have to pay for alternative therapies or services?
  • Which do you help pay for?
  • Which do I have to pay for myself?

Ask yourself:

  • Which services are important to you?
  • Can you afford what they’ll cost?

#3 Got any perks?

In other words: What do you have up your sleeve that I wouldn’t even know to ask about? You could knock out that sinus infection in your jammies – talking to a provider, on your iPad, from your bed, at no cost. Or work with a real-person health coach to meet your specific goals. Or score some discounts on products and services to keep you healthy. Think about which perks you’d use and love.

Ask the insurance company:

  • What are your most popular extra benefits?
  • What benefits do you offer that other companies might not?
  • What new benefits did you recently add?

Ask yourself:

  • Which benefits will you use?
  • What value do they add to your plan?

#2 What if my needs change?

Sometimes it’s expected and sometimes it’s a surprise – but life changes, and so does what you need from your health plan. Know how your plan can grow with you.

Ask the insurance company:

  • What happens if I get a new job?
  • What if I get married and want to change my plan?
  • If I have a baby, how will he or she be covered?
  • What if I develop a serious health condition?

Ask yourself:

  • Do you expect any big life changes in the next year?
  • How might your coverage and health needs change?

#1 Hello? Is anyone there?

You will have questions about your health plan and care, whether it’s when you’re signing up, googling urgent care clinics near your vacation rental or squinting at your test results. Find out who you can call on a Tuesday at 3 a.m. Because no matter who you choose, they’ve got to have your back.

Ask the insurance company:

  • Can I call a 24/7 nurse advice line if I have a health question?
  • Who do I call if I have a question about my insurance, and when are they available?
  • Who can help me pick the plan that’s the best fit for my family?

Ask yourself:

  • Do you feel confident you can get ahold of the right person you need to help you, when you need help?

How to get answers

Having a list of questions is great – but who’s going to answer them? For the best information, call the health insurance company whose plan you’re interested in and ask – it’s what their plan reps are there for! Not only will you get up-to-date info quickly, but you’ll be able to talk with someone who can advise you based on your specific situation and needs.

Health plans aren’t one-size-fits-all – and finding a great fit for your family is important. Talk to someone who can help match your unique needs with the plan that suits you best.

  • Kate Awsumb is a journalist and communications consultant for HealthPartners who has worked with many government, nonprofit, and private organizations to make health information easy to understand and easy to use. Her writing has been featured in the Huffington Post, Men’s Health, StarTribune, Minnesota Parent and the Twin Cities Moms Blog. She holds master’s degrees in health communication and public health, making her a perfect fit for the Health Insurance Help blog.Kate believes health is so much more than not being sick – it keeps us doing what we love, traveling to new places and chasing our kids around the backyard.When she’s not working, you’ll find Kate running, hiking, biking, rowing, snowshoeing, or otherwise on the move with her husband, young daughter and Boston terrier.


    See more posts by Kate >

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