Tips on Health Insurance Coverage

Shopping for the right health insurance coverage can be a confusing experience. Yet, taking the time to review plan benefits can help you avoid surprises when you have to file a claim. Whether you are reconsidering renewal of your existing plan or shopping for health insurance for the first time, the National Association of Insurance Commissioners recommends you read plan materials thoroughly and offers tips for selecting the best coverage for you and your family.

Learn Plan Limits

• The good news is the Affordable Care Act has banned health insurers from placing lifetime limits on most covered benefits. Also eliminated are annual dollar limits in most plans for essential services, such as hospital stays. Yet annual limits for nonessential services still exist. Find out what those services are and select the plan with the highest annual limit.

Estimate Your Costs

• Know your fees in advance by estimating your monthly premiums, annual deductibles and other out-of-pocket expenses before deciding on a health plan. List your medical expenses from previous years, including co-pays for doctor visits, daily medications and visits to specialists. Use this amount to gauge costs for the coming year. Compare expenses for each plan and decide how much you can afford to pay.

Determine Your Access

• Check if your doctor and hospital are in your selected plan's network because your insurer may refuse to pay if your provider is out-of-network. Find out what conditions require prior authorization. This is when your doctor must get the approval from your plan so you can see a specialist, get a new prescription drug, or have a medical procedure done.

Know Drugs Covered

• Review the medications you or other family members use frequently. If the plan's drug list does not include these prescriptions, you may have to pay full price for the medication -- a big expense. If you have already selected a plan, you may still be able to get the drug approved for payment if your doctor says it is medically necessary.

Search for Exclusions

• Scan each health insurance policy and search for services excluded from coverage. Many insurance plans will not pay for hearing aids, infertility treatments, cosmetic surgery or weight-loss and smoking cessation programs.

Determine Plan Quality

• Look beyond price when selecting a health plan. The insurance Information Institute says one way to determine the quality of a health plan is by checking with your state's department of insurance, which tracks disenrollment rates of insurance providers. Find out the number of complaints patients have filed against the insurer. Your doctor also can give you some insight about his experience with the plan.

Ask for Help

• Ask questions if you do not understand the fees, terminology, or benefits in a health plan. Go to the insurance provider's website for more information. Get answers by calling your customer service representative or speaking with your human resources manager if you get your insurance through work. Check if your state's department of insurance offers a consumer's insurance guide for buying health coverage.