With the addition of the Affordable Care Act, many people have been left with numerous questions about purchasing medical insurance for themselves and their family. You want to make sure you have the right coverage and that it is in fact affordable for you. Here are the questions you should be asking yourself and insurance providers before purchasing a medical insurance policy.
1. Does the plan cover my doctor?
Some doctors or hospitals don’t accept certain insurances. If you have a particular doctor for you and or your family members that you would like to continue seeing, then you’ll want to make sure that you can see all doctors and specialists you currently have on this plan.
2. Is it an indemnity plan or managed care?
The difference between the two is an important one. With an indemnity plan, you will pay for a certain percentage of all of your care. They are also known as fee-for-service plans. The advantage with this is that you will typically be allowed to choose your own doctors.
A managed care plan, which can be an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization), means minimal out-of-pocket expense. With an HMO, you or your employer pay a monthly premium, but you can only see doctors in the plan. With a PPO, you or your employer get a discount for using doctors that are within the plan. You can see doctors outside of the system, but it will cost you.
3. Will I have a co-pay or a deductible on top of my monthly premium?
Many times you have to pay a co-pay, which can be as little as $10. However, it can go up from there every time you see the doctor or have to get a medication from the pharmacy.
You might have a certain deductible. This means you’ll pay out of pocket until you have paid your deductible in medical costs before insurance will cover the rest of your medical fees. If you and your family are not often sick and don’t have a lot of medications, then a co-pay might be a better option for you.
4. What does the plan cover?
When it comes to medical insurance, you would think all medical expenses should be covered. However, you might find that you need to get a separate policy for dental and vision or other specialty services. In addition, you’ll want to make sure routine exams are covered. Can you get vaccines? Pap smears? Mammograms? Any other preventative services with your policy?
5. What do I need to do to go to the hospital?
Some plans will require you to contact your doctor before going to the emergency room. This is good to know in advance so you don’t end up having to pay out of pocket for that ER visit.
6. What about pre-existing conditions?
The plan could be restrictive towards pre-existing conditions. They might not cover your care on that chronic condition for months, or ever for that matter. If you or someone in your family has a pre-existing condition, then you’ll need to make sure it will be covered.
7. What happens when I'm away from home?
Let’s face it, things happen when you’re on vacation. Sometimes you’ll become ill or injured and need to be seen by a doctor. You need to be sure that you’ll be covered even if you don’t see your primary care doctor in such a case.
8. What’s the insurance company’s history?
It’s not unheard of for insurance companies to go out of business, leaving your policy null and void. Sometimes if a deal is too good to be true there could be a reason. Perhaps you can only see a doctor during limited hours. Check the history of the insurance company and how long they’ve been in business before purchasing a policy
9. What happens if I have disputes?
The company should have procedures in place for disputing claims or appealing should a claim be denied. You’ll want to be aware of the procedures they’ll follow, and what the average turn-around time is.
Being sure that you have adequate medical coverage can only be helpful to you. Even if you’re typically a well person, you never know what’s going to happen - and you don’t want to be stuck with astronomical medical bills.