Are your doctors in-network?
If you’re lucky enough to have a primary-care doctor you like, make sure she or he is still covered by your insurance provider. If you see several specialists, even on an infrequent basis, make sure they’re all in-network as well you won’t want to have to hunt for a new provider when you’re sick.
It’s also important to remember that some insurance providers or plans may not cover out-of-network providers, even in an emergency situation. For example, if your attending doctor in the emergency room is out-of-network, you may get a separate bill; or your insurance could decline coverage altogether. Make sure you know what your plan’s emergency policies are before signing up.
Are your prescriptions covered?
Even though the Affordable Care Act has mandated that every policy must have prescription-drug coverage of some kind, not all drugs are covered by every policy. If you take prescription medication, it’s crucial to find out whether your insurer will pay. Most insurance companies provide a list of covered medications on their website or on a formulary. Shop around, because out-of-pocket costs can vary between plans from the same insurance provider.
How much will this cost me?
All health insurance policies cost a certain amount per month, called a premium. But keep in mind that many policies have a deductible as well. A deductible is the amount you are responsible for paying out of pocket before the insurance company pays any claim; it can range from zero to thousands of dollars per person, per family. On top of that, even when the deductible has been met, you typically have to pay for part of any healthcare received (called the co-payment). When picking a new plan, make sure you take all the out-of-pocket costs into consideration, not just the monthly premiums.
What’s the fine print?
If your future insurer covers all your prescription meds, your primary-‐care doctor is in-network, and the monthly premium is within your budget, that’s all you need to know, right? Not exactly. The type of plan you’re enrolled in will affect your coverage as well. If your plan is a Health Maintenance Organization (HMO), for example, you will probably need a referral from your primary doctor before receiving any specialty care. A Preferred Provider Organization (PPO) will likely cost more, but it will spare the added hassle of keeping track of all those referrals. And a Heath Savings Account (HSA), the fastest growing type of plan, lets you put money aside on a pre-tax basis to pay for qualified medical expenses. Find out the types of plans your provider is offering and research which one is right for you.