Crucial Questions You Need to Ask Your Health Insurance Agent to Determine How Well You Are Covered
by Emily Harding
Important questions you need to keep in mind when looking for a quality health insurance plan are:
1. What is my out of pocket maximum responsibility if I need to go outside the network (if there is a network)?
Your out of pocket maximum responsibility usually refers to
your deductible and co-insurance or, in other words, the most amount of
money you are expected to pay towards your medical expenses. In an HMO
this can also include hospital admission co-pays. Generally there are no limits
and these can add up. However, a greater danger is needing coverage outside the network and not being covered AT ALL for out of network expenses. PPO plans will limit your liability both inside and outside the network and with a PPO you are covered both inside and outside the network although there is a financial incentive to stay inside the network...
2. Are prescriptions covered as any other
These days many plans do NOT COVER prescriptions. Some may offer a discount on prescriptions which is NOT THE SAME as having the insurance
company pay for prescriptions. Naturally, the plans that cover prescriptions are better.
Are you required to use a primary care physician?
Having to use a primary care doctor should be considered a disadvantage. this is just one method the plan has of taking control and potentially benefits
away from you.
4. What are the exclusions and limitations (what is not covered or only covered on a limited basis)?
Make absolutely certain you read this section! Unfortunately HMO's don't often disclose details of exclusions and limitations.
5. What is the
limitation (the insurance company's policy on covering pre-existing limitations
for individual and family plans primarily however this is something to
consider for groups too
If you are applying for permanent insurance whether individual coverage or group and depending on whether you have maintained prior health insurance coverage or not within the past 63 days before the effective date of the new plan, the plans pre-existing condition limitation may or may not apply