What Questions Should I Ask From My Health Insurance Company?

What happens if I get sick? How much will a visit to a doctor cost health insurance? 

These are typical concerns for everyone. And with the COVID-19, you can’t afford to be without health insurance. That’s why it’s essential to have a good health insurance plan.

But that’s easier said than done. Finding the best health insurance plan can be downright confusing. There’s no need to break out in a sweat just yet. Here’s a guide to get you through everything. This is a list of questions that you should ask your health insurance company before signing any papers. 

  1. Is the plan you’re offering an HMO or PPO?

A health maintenance organization (HMO) and a preferred provider organization (PPO) both cover a portion of your expenses. An HMO gives you access to a selected group of doctors and hospitals. These providers agree to offer discounted rates for plan members. However, you can visit a doctor outside the network with a PPO plan. However, this option is a bit pricier.

  1. Do you offer affordable insurance plans?

Many of us look for affordable insurance plans. However, we don’t understand that the cost isn’t the same for everyone. The cost of health insurance can vary depending on the type of plan and the amount of coverage you choose. If you’re young and healthy, you probably don’t need a lot of coverage. But for those with pre-existing conditions, a more comprehensive plan is a better choice. Since there isn’t a one-size-fits-all solution, you will need to decide which plan fits within your budget.

  1. What are the monthly premiums, deductibles, and out-of-pocket max?

Managing a budget means staying on top of all your monthly expenses. This usually includes utility bills, food, transportation costs, rent/mortgage payments, auto insurance, etc.

Adding to this will be your monthly health insurance premiums (the amount you pay monthly to stay covered). But you will also have to pay the deductible (the amount you have to pay out-of-pocket before your insurance policy kicks in and starts to cover the costs). 

Moreover, you will need to be aware of the out-of-pocket max. This is the maximum amount you have to pay in case you need expensive medical treatment. Consider it a safety net that will help protect you from substantial medical bills. So it’s essential to be aware of all aspects of your health insurance that may influence your budget.

  1. How much coverage does the plan offer?

If you or a family member has a pre-existing condition, you’ll need more medical attention. So it’s natural to worry about whether the plan covers pre-existing conditions and special procedures. 

Often, preventative care is free. This typically includes shots and pre-screening tests. But you should inquire if there are any restrictions on pre-existing conditions.

Some essential aspects of insurance coverage to inquire about include:

  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Outpatient care
  • Dental
  • Vision
  • Pediatric services
  • Prescription drugs
  • Preventive services 
  • Laboratory tests
  • Rehabilitation services

You should also ask how often you see a doctor and specialist as well as the different tiers of protection the insurance company offers.

  1. When does the coverage start?

If you are eligible for employer-sponsored coverage, you need to be sure of when your insurance policy kicks in. Some plans have a waiting period, while others are effective immediately. Though it’s better to wait for a visit to the doctor’s office or medical procedures until the plan begins, you or someone in your family may need immediate medical care, especially if they have a pre-existing condition. You need to be sure of who will be covering the costs for that period.

  1. Is my preferred doctor in the network?

It’s hard to find a doctor that you’re comfortable with and truly understands your health, especially if a particular specialist has been treating you for some time. Not only are you more comfortable with them, but they know your medical history pretty well. That’s often the reason why people are reluctant to change their current health care provider.

Checking to see if your favorite doctor or hospital is in-network can help lower costs. And it overcomes the hurdle of transferring medical records and starting over again.

  1. What’s the copay?

A copay is a small part of the cost that you have to pay for each visit to the doctor. Copays may also apply to prescription drugs, so make sure to ask if your plan covers this. The copay is typically a small amount, but keep in mind that it doesn’t count towards the deductible. So yeah, it’s another hidden cost of health insurance.

  1. How long can my child stay on my health insurance plan?

Currently, the law allows you to keep your child on your plan until they turn 26. This includes children who are married or even those who do not live with you.

  1. What happens if there is an emergency?

In an emergency, it may be hard to find an in-network doctor right away. So what happens then? Hospitals will work with your health insurance provider and allow you to receive as many emergency services as required until you are stable. However, you will still need to verify this. Moreover, you should also inquire about any follow-up care that is needed afterward as well as extra coverage in case of an accident

  • Will I have coverage while I’m traveling?

In most cases, emergency care is covered. But it’s always good to know beforehand.

Final thoughts

Plans are constantly changing, so you may need to reevaluate your current plan and see if there is a better one for you and your family. No matter which one you decide on, always select an insurance company you are comfortable with. More importantly, company representatives should be available around the clock so that you can ask questions whenever you need answers. 

Let me know in the comments what your thoughts are!

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