Questions to Ask Regarding Health Insurance Plans

Choosing health insurance can be a daunting task, whether you are choosing between different plans offered by an employer or selecting an individual insurance plan. As in any other investment, health insurance comes with fine print that must be read carefully. Asking the right questions of health insurance providers can help you determine what coverage is best for you.

Out-of-Pocket Expenses

• Ask what the out-of-pocket expenses are, if you decide to purchase a certain medical plan.

  For most people, the most important question regarding health insurance is the out-of-pocket cost associated with a plan. Knowing how much you can expect to pay for health care services is often the deciding factor when choosing a health care plan.

  The premium, or cost you pay for coverage, is only one part of your out-of-pocket insurance expenses. You must also consider deductibles, co-insurance costs and co-pay amounts.

  The deductible refers to the costs that the consumer is responsible for paying in addition to the insurance premium. For consumers who do not go to the doctor often, a plan with a higher deductible is often suitable; however, consumers who have conditions that require frequent visits to their primary care physician or specialist may wish to select a plan with a lower deductible.

  The same rule applies to co-pays, or the amount the consumer is expected to pay per office visit or prescription. Those who do not take prescription medications on an ongoing basis or make regular office visits may find that a higher co-pay is not a problem, while those who take maintenance medications will find that a lower co-pay is more cost effective.

  Co-insurance costs also should be considered. Co-insurance is the percentage of services that your insurance provider expects you to pay. If you have an 80/20 insurance plan, your insurer will pay for 80 percent of costs, while you cover the last 20 percent.

Providers

• According to the U.S. Department of Health & Human Service's Agency for Healthcare Research and Quality (AHRQ), "more than half of all Americans who have health insurance are enrolled in a managed care plan." With these plans, costs are lower when patients choose medical personnel and facilities that participate in the plan (otherwise known as network providers).

  Determining what your health insurance plan covers, is important when considering a plant. Do you need a doctor who practices close to where you live, or one that can see you at a moment's notice?

Exclusions/ Pre-existing Conditions

• Ask whether or not the insurance company covers pre-existing conditions and/or pregnancy.

  Those who purchase health insurance, either on their own or through their employer, do so in order to have coverage when it is needed. It's important to determine that the health insurance you are considering will cover potential conditions and pre-existing conditions.

  Conditions such as pregnancy and childbirth are sometimes excluded from health plans; women of childbearing age should determine whether or not their coverage will include prenatal and birthing care.

  Those with pre-existing medical conditions also should ask questions pertaining to the coverage of their condition. AHRQ advises that "if you have never been covered by an [insurance] plan... you may be subject to a 12-month preexisting condition waiting period. Federal law also makes it easier for you to get individual insurance under certain situations. You may, however, have to pay a higher premium for individual insurance if you have a preexisting condition."