Author: Kelley Filice Jensen
Obamacare, affordable care act, health insurance reform, Supreme Court, individual mandates, health care exchanges: health care sure has been in the news, and it can be very confusing! But, whether you have health insurance through your work or not, all this talk about health insurance begs the question: what type of health insurance do I need? Where to start? What are my options? Here are 10 questions you need to answer when shopping for health insurance or reviewing your health insurance coverage:
1) Relationship status: single, married, family? Has your status changed? Are you going through a divorce?
A single man in his 20’s that cliff dives or snowboards every weekend has much different insurance needs than a family of four, or even a single man in his 50’s. Any potential health plan starts with who will be covered under the plan and what their lifestyle is. What is yours?
2) What about maternity coverage?
Prior to health care reform, maternity coverage was something to pay attention to when purchasing a health plan, because not all plans contained maternity coverage, and a woman of child bearing age does not want to discover she is pregnant with no health insurance. However, health care reform has defined certain essential health benefits, and maternity coverage is one of them. So, any plan that you are considering will have maternity coverage if you or a loved one need it.
3) Do you go to the doctor frequently?
Do you have a chronic condition or a once a year physical kind of patient? Do you like to be examined by a doctor if you catch the flu or sprain your ankle, just to be safe, or do you refuse to go to the doctor unless it is absolutely unavoidable?
4) Do you have a regular prescription to fill?
Is your prescription something widely available in generic form? How often does it require refill? Ask the pharmacist to give you an example of the retail cost of the prescription if not covered by your insurance. Read here for tips on saving money on prescriptions, and read about preventing medication errors.
5) Do you need a certain doctor or specialist?
Some people will only see a doctor that has been recommended by a trusted friend or family member, others figure that if they have seen one, they have seen them all. If a certain doctor, specialist, health care center or hospital are important to you, double check that the comparable health plans you are choosing between cover your favorite doctor. There are insurance carrier directories listing doctors and networks, or you can call the doctor personally.
6) Do you have a pre-existing condition?
A pre-existing condition is a condition, disability, physical or mental illness that you have before you enroll in a health plan. Pre-existing condition EXCLUSIONS included in a section of an insurance policy that states the plan will not pay benefits for a condition, disability or illness that existed before the policy began. Under provisions of The Affordable Care Act, by 2014, insurance companies will no longer be able to deny coverage based on a pre-existing condition.
When applying for insurance, it is very important to list all medical history accurately and completely. Lying or omitting information about your medical historyis fraudulent.
For more information about pre-existing conditions and The Affordable Care Act, check out this link
7) How much can you spend on premiums, deductibles and copays?
Premiums are the amount you pay every month to have insurance coverage.
Deductibles are the amount you pay for claims BEFORE the insurance company starts to pay. For example, if you have a $1,000 deductible, you will pay the first $1,000 of all insurance covered expenses such as doctor visits and prescriptions.
Copays are the amount you pay, in addition to what the insurance company pays, for each doctor visit, covered service or prescription drug. For example, every time you go to the doctor, you may have a $20 copay.
The more you pay for deductibles and copays, the less you pay for monthly premiums, and vice versa. So, it is important to budget how much you can spend monthly and yearly on health insurance. Learn more insurance terms here.
8) What does each potential insurance plan NOT cover?
Each insurance plan has a list of excluded treatments and services. It is very important to review and understand those exclusions, so you are prepared. Check out these great tutorials all about health insurance, sponsored by Humana.
9) What is your lifestyle?
Do you travel frequently? Where? What kind of coverage do you need if something happens when you are away from home?
What do you do for recreation and leisure? Into extreme sports, or do you prefer the theatre?
How healthy and fit are you? Do you take care of yourself? Many insurance carriers offer discounts and incentives for healthy lifestyles.
10) Do you want an HSA for things not covered by the insurance plan?
Are you a firm believer in alternative medicine? Do you have expenses that you relate to your health but are not covered under traditional medical plans? Things such as acupuncture, chiropractic, dental treatments, contact lenses, physical therapy, just to name a few.
You may benefit from having a Health Savings Account (HSA). This is an account that can be funded with tax exempt dollars to pay for eligible medical expenses not covered by an insurance plan, including deductibles, and sometimes premiums. There are requirements to meet for HSA eligibility, check out these blogs for great information on HSA’s.