Tips for choosing medical insurance
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Choosing the best medical insurance for your needs is an important decision. It can be a challenge to find a plan that is low cost, has a provider plan that meets your needs and has sufficient coverages for your medical needs. Use the following list of questions and tips when researching your options. Carefully compare providers, co-pays, limitations, exclusions, benefit summary, prescription formularies, premiums and reference to your specific needs and health concerns.
- Are all the benefits you need part of the plan?
- Are mental health services covered?
- Are pre-existing conditions covered?
- Are supplies covered?
- Are there dollar limits?
- Are there providers in your home area?
- Are you allowed to see a provider outside the plan?
- Are you talking to an agent, or directly to the insurance company?
- Are your prescriptions in the insurance company’s formulary? What are the co-pays for each?
- As you research the providers, keep records of your questions, conversations, dates, times and who you spoke to.
- Ask other people you know for referrals.
- Be wary of a company that gives a long list of covered expenses. It is much better to go with a company that tells you what is not covered.
- Can the doctors treat you over the phone, when appropriate?
- Can you set up coverage over the phone? Or is a face-to-face appointment required?
- Carefully research your specific medical conditions. Are they covered by the plan?
- Carefully study the summary plan description.
- Check out the insurance company web sites to learn more about their plans
- Does the company have a solid reputation?
- Does the plan pay for substance abuse?
- Does the policy include dental insurance?
- Does your Primary Care Physician treat patients from more than one insurance plan?
- Estimate what your out-of-pocket expenses will be. Compare for each plan.
- Get all information in writing if at all possible.
- How are claims filed?
- How are lab tests covered? Where will you have to go to have lab work done?
- How convenient is the location of the emergency room, hospital, pharmacy, lab and physicians to your home or work?
- How is emergency care handled?
- How long does it take to pay claims?
- How many doctors can you choose from?
- How much is the monthly premium?
- If I have questions before submitting my application, who do I call?
- If you are admitted to the hospital, what hospitals are covered?
- Is preventative care covered by the plan?
- Is renewal of the coverage guaranteed?
- Is the plan a PPO, HMO, POS, EPO or Indemnity Plan? Is it a Catastrophic or HSA plan?
- Is there a deductible? Individual? Family?
- Is there a mail-order service available for prescriptions? Do I save money by using it? Is it required to use?
- Is there a member booklet that explains the plan details? Can you see it before signing up?
- Is there an appeal process?
- Is there coverage for chiropractic care? Physical therapy?
- Is there coverage for infertility treatments?
- Is there maternity insurance?
- Is there online access to my policy, claims, payments, premiums?
- Is this a full coverage plan?
- Make a list of the various insurance companies available to you, and compare features
- Review the list of providers, are the doctors you want on the list?
- What about travel out of the country?
- What are the limits to medical tests?
- What hospital emergency rooms does it cover?
- What if I want to switch primary care providers (PCP)?
- What if you are late on a premium payment?
- What if you have a child that away at college? Adult children that you are supporting?
- What if you have another medical insurance plan? Which one is primary? Can they work together?
- What is covered?
- What is excluded?
- What is the company’s rating?
- What is the co-pays or co-insurance for each visit, prescription, procedure?
- What is the cost for each procedure?
- What is the coverage for ambulance trips?
- What is the coverage for vision? Eye exam? Glasses? Contacts?
- What is the out-of-pocket maximum?
- What is the process for applying for coverage?
- What is the process for seeing a specialist? Do you need a referral?
- What limitations does the plan have?
- What methods of payment do they accept for your premiums?
- When will coverage take effect?
- Where can I purchase my prescriptions?
- Which doctors are accepting new patients?
- Who is covered by the plan?
- Will I be able to get the prescriptions that my doctor feels is best for me?
- Will your plan cover you if your travel?
