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25 Things to know when looking for a new Health Insurance plan

The more informed you are when selecting a new health insurance plan, the better decision you will make for yourself and your family or dependents. Whether you are in the market for a new health insurance plan during open enrollment or during a special enrollment period from having a life event, the more you know about a plan and how it compares to other health care plans, the better selection you will be able to make from the different options available. Comparing plans takes time and you should give yourself plenty of time to answer all the questions you have, so that you can make an informed decision.

The following are 25 questions you should ask when you are deciding between health insurance plans. Please remember to ask these question of your current plan, so you have a baseline to compare against. Some of the questions will have more importance than others to you. You should give the answers to those questions greater importance in making your final decision.

1. Will there be a gap in coverage by switching health insurance plans? If is important to understand the sign-up process for every plan to make sure you do not have a gap in coverage when switching. The sign-up and termination process will be different with every plan. This is especially important if you are selecting a plan due to an unplanned change of employment.

2. Will you be able to keep your current doctor? If keeping your current doctor is important to you, you will want to determine if this is an option. You will also want to find out if the doctor would be considered “out of network” and therefore require you to pay more for his or her services. As a double check, you may want to verify this directly with your doctor.

3. Is there a doctor in the plan that is convenient to where you live? If having a doctor convenient to where you live or work is important, you should determine where the closest location is prior to selecting a new plan.

4. What is the monthly and annual premium for the plan? Every health care plan charges a different monthly premium for the plans they offer. The monthly and annual premium can vary greatly from plan to plan, based on the co-pays, deductibles, out of pocket expenses, coverage options and more.

5. Does the health plan have an urgent care center or hospital near where you live?
Emergencies happen and it is important to understand where you might need to go in the middle of the night or other times when your doctor’s office is closed.

6. How does the plan handle out of network expenses?
There may be circumstances where you want to get a second opinion or need to see a specialist out of your network or plan. You should fully understand what the process is for visiting an out of network doctor and what the coverage would be for such visit.

7. How does the plan handle out of state coverage/emergencies?
Some plans require that you notify them as soon as you have an emergency while traveling or out of state, but every plan is different on how they handle these situations. It is important to know what the plan’s process is and what services would be covered in these circumstances.

8. Does the plan cover vision care? If vision or hearing care is important to you should find out what options are available. Keep in mind that some plans offer referral discounts rather than direct coverage.

9. Does the plan offer dental care or dentist discounts? If dental coverage is important, you will want to know what options are available to you with various plans. Some plans have referral discounts. If dental insurance is important, you may need to obtain a separate policy for that type of coverage.

10. What is the annual maximum out of pocket expense of the health care plan?
Most plans have a maximum out of pocket expense. If a plan has a maximum out of pocket and you think it might apply to you, you should find out how this is calculated and what happens when you reach that level.

11. What are the deductibles/co-pays? Health insurance plan deductibles and/or co-pays vary from plan to plan. The amount you pay can also vary by procedure.

12. What forms of payment does the plan take for monthly premiums and out of pocket expenses? Every health insurance company handles their billing differently. Some may accept credit and debit cards, others may not accept checks or cash.

13. What is the cost to insure additional family members or dependents in the health insurance plan?
If you have children or dependents that require health insurance you will want to understand fully what the cost to insure them will be. Rates will vary depending on a variety of criteria.

14. Where can you get prescriptions filled? Some health plans require that you fill prescriptions at one of their pharmacies or by mail. It is important to understand the process, costs and time frames required to obtain your medications.

15. What happens with prescriptions prescribed by doctors in your existing plan? This is related to pre-existing conditions. Some health plans may require you get a new diagnosis from one of their doctors. If this is the case, you will need to make sure you have time to see a doctor prior to running out of your medication.

16. Does the plan cover mental health, drug or alcohol addiction treatment, smoking cessation or counseling services? If you require these treatments now or may need them in the future, you should determine if the plans you are comparing offers these types of medical services and what the related costs are.

17. How do you schedule appointments? Is there a health plan app? Most health insurance plans now use technology to reduce their expenses and provide a higher level of service. Some plans require you to use their website or app to receive some services or for some communications. You should fully understand how a plan operates to make sure it is consistent with your comfort level with technology.

18. Does the plan cover reproductive/fertility treatments? Some plans offer different levels of coverage for reproduction and fertility treatments, if the availability of these services are important to you, you should determine what the coverage may be.

19. Does the plan offer fitness center discounts or other benefits for being a member? Some health insurance plans provide discounts for fitness centers, trainers and alternative treatments. This is added benefit which may be important to you as you compare health plans.

20. Will you be able to use your health savings account to pay for prescriptions and other out of pocket expenses? Most plans will accept direct payment from your health savings account. Others will require that you get reimbursement from your HSA plan administrator. You will want to understand the process prior to selecting a health care plan.

The following are 5 general questions many people have when switching their health insurance plan.

21. Will you be eligible for Obamacare (Affordable Care Act)? The easiest way to determine if you are eligible for Obamacare or the Affordable Care Act subsidies/discounts, would be to visit and apply. Several States have their own healthcare exchanges, you may be referred to those websites.

22. Does your state have a health care exchange?
You can visit and apply for Obamacare or the Affordable Care Act, when you apply, they will refer you to your state’s exchange, if they have one.

23. Does your state require that you use their health care exchange or the federal exchange? The primary purpose of the exchange is to determine eligibility for the health care subsidy. If you are not eligible for it, you can obtain insurance from an insurance agent, broker or directly from a health insurance company.

24. If you are looking for insurance because of a change in employment status, you will want to know if you are eligible for COBRA and what the associated costs are. When you have a change of employment and are no longer eligible for employer provided health care, you may be eligible to continue your former employer’s health coverage through COBRA. You will want to understand the cost of this and how it compares to getting a health insurance plan on your own.

25. Does having a pre-existing conditions impact your coverage?
Insurance companies can no longer use pre-existing conditions to make coverage or rate decisions. You should however understand how pre-existing conditions are handled as it relates to your current medications and treatment plans. Some health plans may require you to get diagnosed by one of their health care providers before they prescribe medications or treatments.