[su_box title=”Keep in mind…” style=default”]

  • When shopping for health insurance, you need to take into consideration your current medical status
  • The price of deductibles and co-pays will vary depending on the type of health insurance coverage you choose
  • Certain insurance plans only allow you to see “in-network” physicians


When comparing health insurance policies, you probably have a million questions. Which ones are important? What questions should be asked any time you are considering a health insurance policy?

There are several important factors to any health insurance policy that the consumer should be aware of. Health insurance rates are important, but it is only one factor in getting “good” coverage for yourself and your family.

Here are some questions you should ask when you are looking at health insurance.

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What is covered?


Although it’s a standard question, not everyone takes the time to investigate what their health insurance plans actually cover far too many people have gotten a “good deal” on health insurance, only to find that the policy does not cover their needed medical expenses.

Are you regularly taking a certain medication? Will that be covered under the plan? What about office visits? Does the plan cover routine screenings, such as mammograms or prostate checks?

The answers to these questions will determine if your coverage is sufficient. Make a list of all the medical visits you have had over the past few years.

If you are generally healthy and usually don’t go to the doctor, you may not need coverage that pays for office visits.

On the other hand, if you have children and are at the doctor’s office every other week, it makes sense to get a policy that covers this, at least in part.

What are the deductibles and co-pays?


Lower health insurance deductibles mean higher premium costs, but they also mean less out-of-pocket expense for you if you are sick.

If you visit the doctor on a regular basis, co-pays need to be taken into consideration.  Be sure to fairly estimate the amount you will spend out-of-pocket, and think about setting up a health insurance savings account if those amounts are high.

What percentage does my plan pay for various expenses?

Health insurance companies say that they cover 90 percent of your expenses, but this may not include many tests and services that you require.

What if you require regular blood work and your plan only pays for 50 percent of those costs?

Most plans have different percentages for different tests and procedures, so be sure to look at the plan’s literature carefully before making your decision.

Are there network restrictions?


Many plans require you to visit certain doctors and providers for your health coverage. If this does not bother you, then it may be sensible to invest in the plan.

However, if you have a favorite doctor who is not in the company’s network, you will either have to pay the doctor yourself or accept a reduced coverage rate from your company.

You can ask your doctor’s office if they are in-network, or you can look it up on the company’s website. You can also encourage your doctor’s office to join the network if they are not currently members.

What about prescription coverage?

Some plans do not cover prescription drugs while others only cover a very limited list. Furthermore, some drugs are on different “schedules,” so the company may pay only a percentage of those costs.

If you are currently taking any regular medications, be certain to investigate this aspect of the plan. If you must visit a doctor and you receive a prescription, be sure to check whether it is covered.

If not, you may ask the doctor about substituting another form of the drug or a different brand.  Some medications, however, do not have generic substitutes.

In addition, some doctors are reluctant to substitute a formulary due to the side effects or actions of a particular drug.

If you do your homework, you can find a plan that meets your needs and is affordable. Your doctor may be able to help, or you might be able to find answers on the company’s web site.

An ounce of prevention is worth a pound of cure! Use our FREE online tool to find affordable health insurance plans in your area!

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

  1. https://www.healthcare.gov/blog/6-things-to-know-about-deductibles-in-the-health-insurance-marketplace/
  2. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/
  3. https://en.wikipedia.org/wiki/Health_savings_account
  4. https://www.verywell.com/health-insurance-deductible-what-it-is-how-it-works-1738655
  5. http://www.medicinenet.com/script/main/art.asp?articlekey=46204