Imagine opening up a hospital bill for last month’s procedure, and it’s way more than you expected. You don’t understand why it is so high, especially since it was within your network coverage. This happens way too often because people are unaware of how insurance works, and what their plan covers.
No one looks forward to those hour-long (or more) calls with their health insurance company to resolve issues. For some, it can be more than tedious; it can be a reason to choose a different plan.
Even with the best company, you may find yourself in situations that call for shopping around like:
- A new health issue that needs to be taken care of
- Losing your job
- Starting a family
- Getting kicked off your parent’s plan.
Whatever the reason, there are a couple of very important questions you should ask when shopping around.
1. How Much Do Plans Cost?
If you’re looking into health plans, you should already be familiar with general budgeting. Day-to-day life involves balancing rent, utilities, and other necessities.
When looking into health insurance, “how much does it cost?” is most likely your first question, and for good reason. There are premiums, deductibles, and copayments that you should ask about before purchasing. While these terms may sound confusing at first, you’ll be up to date in no time.
A premium is the fixed monthly rate that you pay the insurance company to cover you and your family. Remember that premiums do not go towards your deductible.
Your premium’s cost is determined by a few key factors. Most insurance companies will underwrite you first, which means that they gather all your health conditions and from those determine your “risk factor.” Other factors include your age, lifestyle, and sometimes where you live.
The deductible is a fixed amount you must pay before the insurance company either reimburses you or covers medical expenses. For example, if your deductible is $1,500, and you go to the doctor and get a procedure $3500 done, then you must pay $1500 first. Then, your company should take care of the last $2000.
2. Which Plan Offers The Coverage I Need?
After you determine how much you’re willing to spend, your next question should be about which medical concerns you need covered. There are so many different plans that you can compare and choose from.
Health Maintenance Organizations (HMOs) gives you access to doctors within its network, while Preferred Provider Organizations (PPOs) offer a wider network at a higher price. There are also different tiers of plans. There is the gold plan, the silver plan, bronze plan, and the platinum plan. All plans range at different prices for different coverages.
If you want a low monthly premium payment and are in good health, then the bronze or silver plans are best. Gold and platinum plans have a low deductible but higher premium cost and these work best for people with medical issues that require tests, surgeries, and prescriptions.
3. Are Pre-existing Conditions Covered?
If you have a pre-existing condition, such as diabetes, heart disease, or COPD, then some health insurance companies will not cover you. Ask all companies about coverage for your pre-existing conditions, because some will simply turn you away considering you high risk, while others will overcharge you. It’s important to verify this first before you get invested.
4. How Long Is The Waiting Period?
Some health insurance companies require a waiting period when you first enroll in a plan. Typically the waiting period is a month, while others could have different time frames.
If your medical conditions require more payments, then plan accordingly for no gaps as you switch coverage. This is especially true for people with conditions that require tests, prescriptions, and such.
5. Is My Doctor In-Network?
When picking a health plan, if you want to keep your current doctor, then make sure they are listed in your company’s network. Health insurance companies work with different doctors and hospitals. You can find out if your doctor is covered in the plan by asking the company or asking your doctor’s office directly.
6. Is The Plan Only For The State I Live In?
This question pretty much goes hand in hand within your prospective plan’s network. By asking your agent, you can find out how far your coverage extends. Some plans even go international. It would be a shame to get hurt while visiting a loved one in another state and come back home to a $10,000+ hospital bill–all because it was out of network.
7. Are There Any Perks like Telehealth?
Some plans offer telehealth, where you can virtually talk with your doctor, or call them over the phone to diagnose your illness. After, they send your prescription to a nearby pharmacy. It’s definitely a convenient perk to watch for.
This would eliminate travel costs and wait time at a physical clinic.
Some plans offer free classes and different apps that you can use to stay up to date with your doctors.
8. Who Can I Call With Questions?
Most people agree that when it comes to health insurance companies (other than the unexpected bills you get) the long phone calls are the worst part.
There is usually a customer service number that you can call, but it’s common to be transferred several times, and even put on hold. Some have direct numbers/agents you can speak with to answer the specific questions you have, and others have chat services installed on their websites. Most will have informational forums you can peruse to find what you need.
Automated phone systems are the worst. If you are in the market for a health insurance plan, eliminate all the hassle and contact an agent. EZ.Insure offers highly trained agents within your region that can answer all of the questions listed, and more. Speak with an actual human being, not an automated phone system. Get the answers you are looking for quickly and at no cost. We will provide you with your own agent who will search and compare all available plans in your area, for free. No pressure, no gimmicks. To get instant quotes, enter your zip code in the bar above. Or if you would like to get specific answers, speak to an agent by emailing firstname.lastname@example.org or calling 888-350-1890.