Questions To Ask Yourself When Choosing A Health Insurance Plan

November 21, 2017  |  
1 of 15 at the doctor

Choosing a health care plan is such a daunting task. None of us want to need a health care plan. You have to put so much time and thought (and money) into something that you hope you never, ever need. That’s certainly not as enticing as picking out a vacation spot or a new car. Choosing a plan can also feel like a gamble sometimes. If you make one little choice wrong here or there, it can cost you thousands of dollars in the future. When you’re picking out a health insurance plan, it’s one of the few times in life that being optimistic and expecting the best is a bad idea. The whole point of health insurance is to be prepared for the worst. But, you can’t have a total doomsday attitude or you’ll wind up paying for add-ons that really don’t apply to you. Here are questions to ask yourself when picking out a health insurance plan.

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Does it cover my primary care doctor?

You have a relationship with your current primary care doctor. She knows your history. You have a rapport with her and feel comfortable telling her everything. If you change primary care doctors, you’ll have to have all of your documents transferred to your new doctor. For some, having to do that isn’t a hassle, and they are comfortable talking to new doctors. But if that’s not you, check to see if your new plan would cover your old doctor.


How many doctors are in the network?

Don’t be lured in by a budget plan: check how many doctors are in the network, first. You may find that the budget plan has barely a quarter as many in-network doctors as the other plans have. That will make a huge difference when it comes to the emergency, walk-in visits.

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How many in-network doctors are close to me?

If you live in a high-traffic area like Los Angeles, then having a doctor who is just five miles away could mean rerouting your entire day to make it to an appointment. Make sure you have in-network doctors within reasonable driving distance. If getting to your doctor is a hassle, you’re likely to postpone and skip visits.

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How available are doctors to new patients?

When I last changed plans, I tried to make an appointment for my annual physical with a new primary care doctor. I had to call five doctors before I found one who didn’t say, “Sorry. We aren’t accepting new patients right now.”

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Is there an urgent care nearby?

It’s very important that you have an in-network urgent care within a reasonable distance from your home. We don’t want to think about emergencies and needing urgent care, but when they come up, you don’t want to find yourself an hour drive from the nearest in-network clinic.

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Do I see specialists often?

If you see specialists often, that’s something to think about. Are the in-network specialists with this plan good? Experienced? Reputable? Are there enough of the types of specialists you need in your network such that, if your regular one went on a trip, you could still see another one in an emergency?

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What do specialists cost?

Another thing to consider if you visit specialists regularly is the specialist visit cost. In some plans, you may see a high premium, but that’s because specialist visits only cost $40. In others, you may see a low premium, but that’s because specialist visits cost $100. That’s something to think about if you see a specialist every month.

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Do I have a lot of prescription drugs?

Some premiums are quite low because the prescription drug copay is high. That’s not a big deal if you’re a healthy individual who only picks up one prescription a month. But if you currently have a lot of regular prescriptions, or might have some in the foreseeable future, a $75 copay for drugs becomes a huge deal.

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Could I afford the higher deductible?

Sometimes, you go for the lower premium with the higher deductible because then you’ll definitely save money so long as nothing happens. If you go with the high premium and low deductible, you may wind up paying that high premium for nothing if you don’t have any medical events. Just make sure that if you go for the low premium you could pay the full deductible, should something occur. If you’re in very good health, lead a safe lifestyle and could pay the high deductible if necessary, then getting the low premium makes sense. You’ll probably reap the financial benefits.

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Percentage covered to deductible ratio

It may seem like a plan that covers 80 percent of bills after the deductible and a plan that covers 90 percent after the deductible aren’t that different. But if you have a condition that could require a $12,000 procedure, that extra ten percent in coverage goes a long way.


Do I travel often?

If you travel a lot for work, it’s important that you can find in-network doctors most places you go. It’s certainly important that you can be covered when traveling to a foreign country.

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Does it cover therapy?

If depression, anxiety, or other mental and emotional disorders run in your family, make sure your plan covers therapy and psychiatry. These can be quite expensive on their own.


Do I plan on becoming pregnant?

If you plan on having kids in the near future, make sure you get a plan with an awesome reproductive program. It should have extensive reproductive benefits, as well as reputable OBGYNs and other reproductive specialists in-network.

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Do you qualify for discounts?

Don’t forget that you may qualify for health insurance discounts. AARP members, for example, are eligible for some health insurance discounts. If you are a member of such a group, ask if it offers discounts.


Is it user-friendly?

It’s important that your health insurance is user-friendly. That means it should have a website that’s easy to navigate, a customer service line that doesn’t leave you on hold for hours, and perhaps handy things like smartphone apps.

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