Questions to Ask When Applying for Health Insurance

Health insurance is a critical safeguard against incurring enormous medical bills due to unforeseen health problems or accidents. If you do not have a plan that is comprehensive, or one that fits your specific needs, you may find that your insurance fails when you need it most. There are questions you should ask when applying for health insurance to ensure that your plan best suits your needs.

Out-of-Pocket Limits

• It is important to ask about the out-of-pocket monetary limits on an insurance policy before you decide to purchase that policy. Insurance companies typically use a co-pay or co-insurance payment plan for medical procedures, hospital visits, and prescription drugs. A co-insurance payment plan stating that you must pay twenty percent of the cost of a procedure or prescription drugs may not sound incredibly expensive, but the cost can be substantial at the end of a fiscal year. For example, according to a 2010 article in the New York Times, cancer patients can commonly pay $40,000 in a year for medication, which equates to $8000 in out-of-pocket money. Out-of-pocket limits will protect you against seemingly insurmountable medical bills, should serious illness occur. Asking an insurer what type of out-of-pocket limits are available will protect you from serious financial obligations in the future.

Payment Plan

• Ask what type of payment plan your health insurance policy will use. Insurance companies typically offer three types of payment options for medical bills: co-payment, co-insurance, and a modified policy that uses both options. Co-payment plans state a set amount that you must pay for a procedure after paying your deductible. For example, if your policy states that you must pay $30 for every doctor's visit, then you would pay $30 per visit no matter how many times you visit the doctor. Co-insurance payment options specify a percentage split that you and the health company must pay. For example, a 20/80 plan would mean that you pay 20 percent of any medical bill incurred, up to a certain amount. There are usually different co-insurance rates for different medical expenses, and it is important to ask what expenses correspond to what percentage.

Deductible Amount

• A critical question to ask an insurance provider is the deductible amount that you must pay for a policy. Typically, you have to pay the entire deductible amount of your policy for the year before the monetary benefits of your insurance apply to medical bills. This means that if you have a 40 percent discount on prescription drugs with a $500 deductible, you must spend a total of $500 on drugs for the year before the discount applies.