What to look for in health insurance plans
5 things to consider when choosing your health coverage
Choosing a health insurance plan can seem like a daunting task. Here are five things to consider when choosing health coverage for you and your family. For specific information about plan components, refer to your plan’s Summary of Benefits and Coverage (available from an insurance company), call the insurer directly, or visit the insurer’s website.
1. plan type and provider network
Are the health care providers, hospitals, and pharmacies you prefer in the plan’s network?
It’s important to remember that in-network services and drugs are covered by a plan, while out-of-network services and drugs may require additional out-of-pocket costs or may not be covered at all. More importantly, out-of-pocket costs for out-of-network services may not count toward a plan’s out-of-pocket maximum. Check to see if your preferred primary care provider or specialist and pharmacy near you are included in the plan’s network.
How much will you pay per month for coverage?
Premiums are the amount you pay an insurance company for coverage, whether or not you use medical and pharmacy services. premiums are usually paid monthly, and if you stop making payments, you risk losing your coverage. Keep in mind that these aren’t the only costs associated with coverage. You will also be responsible for paying deductibles and cost sharing, such as copays and coinsurance, for most health care services and treatments. (see descriptions below)
what is the amount you have to pay out of pocket before your coverage kicks in?
For example, if your deductible is $1,000, your health plan won’t pay for most costs until you’ve spent $1,000 in out-of-pocket costs. Out-of-pocket costs can include specialist visits, procedure fees and, in some cases, even prescriptions. Certain preventive services, like approved cancer screenings and immunizations, are generally covered at no cost-share before you meet your deductible. patients who select a plan with high deductibles will likely have a lower monthly premium, while those with lower deductibles often have higher monthly premiums. Insurers increasingly require that a deductible be met before most medical or pharmacy services are covered. Be sure to check with your insurer to see if your plan has a combined single deductible for medical and pharmacy services or a separate deductible for prescriptions to find out how much you’ll have to pay before medications are covered.
4. copay or coinsurance
Are you aware of other costs you may be required to pay to access care?
Don’t forget you may be responsible for other out-of-pocket costs even after you meet your deductible. these may include:
• coinsurance – a percentage of the costs you must pay for a drug or service, or
• copay: set fees you must pay for prescriptions or covered services (often found on the back of your insurance card)
5. drug coverage
Does your insurance plan cover your regular prescriptions?
Each insurer has a formulary (list of drugs) covered by the plan. if a drug is not on the formulary, it may not be covered and patients will have to go through a potentially lengthy process to obtain coverage. The List of Covered Drugs is also divided into tiers, which determine how much copayment or coinsurance you’ll have to pay. Make a list of your current medications and compare it to the plan’s formulary to make sure your medications are covered and that you understand any out-of-pocket costs that may be associated with them.