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Questions to Ask When Comparing Health Insurance Plans

Insurance shopping, Part II

by Mark Dunn, Ohio Insurance Options agent

(Please read What am I looking for in a health insurance plan?, Insurance Shopping Part I)

Now that you have a good idea of the type of health plan that best suits your needs. The list of questions below will help you evaluate each plan and compare it to other plans in your price range. Always ask questions, if your agent can not answer the questions you have, find an agent that can.

*Is the plan a PPO (Preferred provider Organization), HMO (Health Maintenance Organization), or Indemnity Plan?

*How much is the deductible of the plan?

*What is the co-pay percentage after the deductible has been reached? Typically it will be 100%, 90/10, 80/20, 70/30, 60/40, or 50/50. Typically the company will pay the larger percent for example in the case of an 80/20 plan, the company will pay 80% and you will pay 20%, until you have reached your maximum out of pocket expenses as stated in the plan.

*What is the plan’s maximum out of pocket expenses for you or your family? Does the maximum out of pocket also include all other deductibles? Does the maximum out of pocket also include the co-pay in the plan? Ex: office, prescriptions drug, emergency room visits?

*Does the plan have an annual or life time benefit maximum?

*Does the plan offer doctor’s office co-pay? Is the office co-pay the same for general practice and specialist visits? What is covered with the office co-pay? Typically most plans only cover the physician consultation and records. All other charges are applied to your deductible.

*Do urgent care visits have the same co-pay as general office visits?

*What do you have to do if you need to see a specialist?

*If the plan is a PPO or HMO, does it cover you if you see a physician outside the network?
*Will the plan cover adult preventive care? Is there an annual dollar limit for preventive services?

*Does the plan cover well-baby care and immunizations?

*Does the plan cover chiropractic care, dental, or vision?

*Does the plan offer prescription drug co-pay? Does the prescription drug plan have a separate deductible or annual benefit cap? Will the plan cover the prescription medicine(s) you are currently taking?

*Has the company had a high number of complaints against them with the department of insurance?

*How does the company handle preexisting conditions?

Armed with the answers to the above questions you should be prepared to make a fair comparison of the different plans available to you and make an informed decision on the health insurance plan that is right for you.