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Questions to ask When Evaluating Health Insurance Plans

When you are preparing to purchase new health insurance plans, your decision can be greatly simplified if you know the right questions to ask. These are the most essential questions you should ask when evaluating health insurance plans today.

What is Covered?

Determine exactly what each policy covers. This can vary greatly. For example, one policy may cover only a few physician visits a year while another more extensive policy may cover monthly visits if needed.

Further, some policy types don't cover routine medical care like checkups and doctor visits when you get sick. These policies are designed to cover only one type of event--an emergency event that qualifies as catastrophic. This type of policy may also be referred to as "hospital only."

Some policies will cover your prescription medications, but many policies will not. Since this can be a significant cost for many today, it is important to ask if you'll have any prescription coverage. Further, if you do have prescription coverage you should ask if only generic medications are covered (common in many plans today) or whether you can also get name brand drugs under the plan.

Another variation in what policies cover is preventative care. Some health insurance policies will pay for their participants to get preventative care like screenings for diseases or vaccinations for the flu, for example. However, other policies cover only medical visits when there is actually a medical issue.

What Policy Types are Available?

Major health insurance providers like Blue Cross Blue Shield, Health Net, Kaiser Permanente, and Aetna offer a range of policy types to meet the needs of virtually any buyer. The most common variety of policy today is the Health Maintenance Organization, or HMO, policy. People who participate in this type of plan are able to visit doctors and health care providers who are in a pre-selected group designated by the plan providers. Patients will normally have the lowest out of pocket costs with an HMO, however their options for choosing their medical care may be much more narrow than with other types.

Another option is Preferred Provider Organization plan, or PPO plan. This coverage resembles an HMO in many ways however the patient may seek care from outside of the designated network and still be covered by insurance. However, PPO patients who elect to get treated outside of the PPO network will pay a higher portion of their medical costs than in network patients.

The Point of Service plan type, or POS, plan type provides its customers with a medical coverage policy but requires more from participants than the other two plan types do. The POS plan will merge features of an HMO plan and a PPO plan. Essentially, the plan participant will have a limited network in exchange for a cheaper monthly premium. Although it is permitted to visit a doctor outside the network, that has to be approved by primary care doctor who can send patients to a specialist.

It is vital that you choose your new health insurance provider carefully and that you discuss it completely with the experts!

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