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10 Questions to Ask When Choosing a Health Insurance Plan

Close up of to health insurance application on a tablet device and illustrating 10 questions to ask when choosing a health insurance plan.

Shopping for health insurance, especially for first timers, can look pretty daunting. While the agents working for the Affordable Care Act and Covered California can help you find a good plan, there are still some things you need to consider when choosing health insurance policies. Here is a list of important questions you should ask before you buy individual health insurance.

What Does the Policy Cover?

Too many people don’t know exactly what they are purchasing when they buy health insurance. Many health insurance companies adhere to the standards set by the ACA for their affordable health insurance plans, however you should make sure that the medical insurance you purchase meets or exceeds those standards in order to avoid potential tax penalties. Per the 2017 standards set by the ACA, you should make sure that your individual medical insurance offers the following essential health benefits:

  • Emergency services
  • Prescription drugs
  • Hospitalization
  • Laboratory tests
  • Mental health and substance-abuse treatment
  • Outpatient care
  • Maternity and newborn care
  • Pediatric services (including dental and vision)
  • Preventative services (such as mammograms, immunizations, and diabetes monitoring)
  • Rehabilitation services

2. How Much Does It Cost?

California health insurance and other insurance through the ACA is designed to be affordable, but offer several different tiers of payment options. Platinum plans will require you to pay a lot on your monthly premiums, but your co-pays will cost less, making it a good option if you frequently require medical services. Bronze plans have a much cheaper monthly premium, however you will pay more out of pocket if you receive healthcare, which is ideal for people who don’t have a lot of medical needs. Gold and Silver plans are in-between.

It is recommended that you look at your health needs and your budget in order to purchase the best health insurance for you. Compare health insurance plans and look over all the health insurance quotes offered to you to help narrow down your decision based on the cost, coverage, and your needs.

3. Can I Still See My Current Doctor?

If you have a physician that you are satisfied with, you should ask if there are any limits on choosing your doctor or hospitals in the insurance plan. Every health plan has a network of providers, so check to see if your doctor is listed among those included in the policy’s network. If they are not within the network and you still visit them, the insurance company may require you to pay a higher share of the cost or may not cover the bill at all. It’s worthwhile to check the provider’s directory to see if your physician or preferred hospital is included.

4. What Benefits Are Included in the Plan?

Aside from the essential coverage required by the ACA, it’s worth seeing if you get extra benefits in your health plan. Ask if the plan includes vision, dental, or coverage for other forms of care. If such benefits aren’t included, see how much it would cost to get such benefits added to your policy. It might be worth the price.

5. Are Prescriptions Included?

While Covered California plans and other plans purchased through the ACA Marketplace provide coverage for prescription medication, some individual health plans do not. It is important to know if your plan can cover prescription drugs, especially if you have an ongoing prescription.

6. Does the Plan Have Restrictions on Pre-Existing Conditions?

While 2017 Covered California and ACA plans cover pre-existing conditions, some independent or private health plans might not. If you or someone under your policy has a chronic condition, you should ask if your health plan is able to cover it. There are some policies that might not cover related medical costs if treatment is continued past a certain period of time.

7. Are Routine Check-Ups Covered?

Many doctors agree that the best medical care is preventative care. Catching health problems early increases your chances of speedy, healthy recovery. While most preventative care such as check-ups, physicals, mammograms, and immunizations are covered in Covered California and ACA health plans, you should ask your insurance provider about coverage for such care if you purchase a private plan.

8. How is Emergency Care Handled?

Ask your provider about how coverage works for emergency care such as hospital stays, ambulance rides, MRIs, X-rays, and other such services. Some policies may require you to contact your primary care physician within 24 hours of receiving emergency care or your costs won’t be covered. It’s important to know what steps your policy requires in order for you to get full use of your coverage.

9. Is the Insurer Financially Stable?

If you choose a plan outside of the ACA/Covered California Marketplace, you should take extra steps to investigate the insurance provider. Find out how long they have been in business and read up customer reviews regarding their products and services. They may offer low-cost premiums that are too good to be true or limitations such as only covering doctor visits within a limited time frame.

10. How Does the Insurance Company Handle Disputes Over Claims?

Every insurance plan has procedures in place for appealing denied claims, but they aren’t all the same. Some plans might require to take your dispute to an arbitrator rather than going straight to the courts. You should also ask the insurance company what the average turnaround time is for resolving claim disputes. It could range anywhere between days to weeks to months before a disputed claim is resolved. It is best to know what you’re getting into in case the worst scenario happens.

Now that you know what to ask for when shopping for a health insurance plan, why not get the plan you need through Freeway Insurance? Freeway has teamed with up Covered California to help find you the best affordable healthcare plan available. Call us at (800) 777-5620 now or get a free health insurance quote online today!

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