When shopping for health insurance, you need to compare quotes from many different health insurance companies to get an understanding of rates, terms, coverage and any exclusions or limits. There are so many differences in policy details that comparing health insurance companies just by the cost of premiums is never enough.

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What should I know about health insurance rates?

AdobeStock_62082716-1600x1600Most consumers are primarily concerned with how much premiums will be. While costs vary depending on an applicant’s region, age, current health and other factors, there are some basic costs that are associated with most health insurance plans.

The following are common expenses that participants usually have to pay:

– Premiums

The premium is the yearly cost of the health insurance coverage. All applicants want to know how much a plan’s premium will cost, but they should also inquire as to whether the premium must be paid upfront or if it can be broken into monthly payments.

– Deductibles

A deductible is a monetary amount that has to be paid out-of-pocket for medical services by the insured before the insurance company will begin to pay for the medical services.

You should find out what areas of the coverage have a deductible, how much the deductible is and what out-of-pocket expenses will count towards fulfilling the deductible.

– Co-payments

Co-payments are partial payment for health services such as doctor visits, emergency room visits, and prescriptions.

You should find out if a plan’s co-payments are a set amount or a percentage of the bill and ask if a plan has different levels of co-payments for specialists, brand name prescriptions or particular health services.

What questions should be asked about coverage?

While most consumers are primarily concerned about the cost of health insurance, the exact details of coverage is really the most important issue. It doesn’t matter how inexpensive the plan is if it does not cover an applicant’s health care needs.

Firstly, you need to know what basic health services are covered. Routine services such as check-ups, well visits, emergency room visits and prescriptions are important services to have covered.

Some health insurance plans have high deductibles and may even exclude some of these from standard policies.

Next, you need to ask about higher-level services and procedures such as seeing a specialist, surgery and long-term care in the event of a serious illness or injury.

You can also inquire about options such as dental and vision coverage. While most health insurance companies do not include dental and vision in most plans, you still need to know if they are included.

Other options to inquire about include fertility treatments, mental health services and alternative treatments providers such as chiropractors.

What questions should be asked about exclusions?

AdobeStock_33004710-1600x1600After finding out what the plan does cover, it is also a good idea to find out what areas and services are not covered. Many companies will not cover medical services that are not deemed “medically necessary.

Services such as fertility treatments, weight-loss surgery, cosmetic procedures, or sterilization procedures (such as a vasectomy) might not be covered.

In addition, applicants should ask if there are any prescriptions not covered; some companies will not pay for prescriptions that are not medically necessary or until there is a generic version of a brand name drug.

Lastly, an applicant should inquire about a company’s policy for excluding pre-existing conditions. Many companies will exclude coverage for pre-existing conditions such as diabetes, heart problems and cancer.

Each state has its own laws about how long an insurance provider can exclude coverage for pre-existing conditions.

What questions should be asked about limits?

While health insurance companies can no longer impose lifetime monetary limits on an individual’s or family’s health insurance costs, they still are able to impose annual limit amounts on how much the company will spend covering a plan for a year. Annual limits are important to know if injury or illness strikes.

Companies also have limits on certain procedures, surgeries, and health services. They generally will only pay what is deemed usual, customary, and reasonable. Applicants should inquire as to how the company sets the parameters for such services.

What questions should be asked about health service providers?


Another set of important questions concern the health service providers that a plan will support. Some

Generally, if a health care provider is not on the list, then the insurance will not pay for services from that provider; some will only provide partial payments to non-network providers.

It is important to know how large a network of providers is and if those providers are a convenient distance from home or work.

If the plan does not have a wide selection of providers, or providers that are close enough, then it is more likely that a participant will not use the insurance enough to justify the cost.

It is also important to find out what an insurance company’s payment policies are for services rendered out of state or even out of the country if a participant is traveling.

Comparing health insurance plans by details is essential to finding the best health insurance rates but it does take some and you need to ask questions.

Get started by comparing health insurance companies in your ZIP code today by entering your zip above.

[su_spoiler title=”References:” icon=”caret-square” style=”fancy” open=”yes”]

  1. http://www.webmd.com/health-insurance/insurance-costs/insurance-cost-calculator
  2. https://www.healthcare.gov/glossary/out-of-pocket-costs/
  3. https://en.wikipedia.org/wiki/Copayment
  4. https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs2.html
  5. https://www.healthcare.gov/coverage/pre-existing-conditions/
  6. http://www.healthcostinstitute.org/
  7. https://marketplace.cms.gov/outreach-and-education/what-you-should-know-provider-networks.pdf


[su_spoiler title=”References:” icon=”caret-square” style=”fancy” open=”yes”]

  1. https://www.healthcare.gov/how-plans-set-your-premiums/
  2. https://resources.ehealthinsurance.com/individual-and-family/different-types-health-insurance-plans
  3. http://obamacarefacts.com/health-insurance/copay/
  4. https://en.wikipedia.org/wiki/Health_insurance_in_the_United_States
  5. https://www.medicaid.gov/
  6. https://www.verywell.com/major-medical-1738592
  7. https://www.medicareinteractive.org/get-answers/programs-for-people-with-limited-income/overview-of-help-paying-for-prescription-drugs/my-income-is-low-are-there-programs-that-can-help-pay-for-my-prescriptions