Ten Questions to Ask Before You Choose a Health Plan

Living a healthy life with complete assurance from illnesses, disease, and untimely health emergencies seems impossible with the prevalence of sickness in the world. This is why a health plan is so important.

While we agree that ‘health is wealth,’ our forebears of the language might have missed mentioning one tiny detail.

Health is a luxury; rather, a privilege that many American citizens are deprived of due to unaffordable healthcare. Maintaining one’s health requires a lifestyle that is either too difficult to approach or a fortune that threatens to drain your savings without a contingency plan.

But, choosing a healthcare insurance plan is not as easy as it seems. Each insurance plan has its limitations by its parent company as well as legal deductibles that many people do not prefer to ask prior to registration.

To know more about how to choose a safe health plan, we have discussed ten questions that you might need to ask yourself before opting for insurance.

1)    Which Insurance Health Plan is Ideal for me?

Shopping for health insurance can be tricky, especially when you are opposed to coverage plans that might appear to be the best for you. But, just because your colleague shopped for an enthusiastic US health group insurance coverage plan that ensures his entire family, does not mean it will work out the same for you as well.

Choose a coverage plan that best suits your needs and rests within your budget and flexibility.

For instance, if you are already diagnosed with an illness and frequent hospitals on a routine basis, you might have to opt for a healthcare policy that reassures you constantly.

Otherwise, indemnity plans to work perfectly for individuals who plan on opting for health insurance with coverage limited to expenses rendered for accidents and emergencies.

An indemnity or individual plans also provide discounts on physician consultations as well as prescriptions. Choose a coverage plan that pays for your medical expenses rendered due to frequent admissions to the hospital or weekly consultation visits.

2)    What is a Premium?

A premium is an amount that is payable in return for the benefits or features of your health insurance coverage plan.

The lengthier the coverage, the higher will be the premiums that you will be required to pay on a monthly or annual basis. Shop for a coverage plan that provides you the features that you require in exchange for low premiums.

Sure, high premiums translate as exhaustive coverage, but do you really need benefits that you will probably never put to use?

3)    Are the out-of-pocket health plan costs negotiable?

While premiums are fixed, each health policy plan comes with a set of varying costs that you can negotiate with your policy provider. These varying costs include deductibles, copayment, and coinsurance that might seem overwhelming, but in reality, they are not when your insurance period begins.

Before choosing a health policy plan, make sure you enquire about the percentage of costs that you will have to pay once you are charged with your premiums.

The rate of deductible and copayment depends on the policy you choose and is usually in line with the amount of premiums involved.

If you choose a plan that has lower premiums, you will be charged with higher deductibles as well as high copayments every time you go to the clinic. Higher premiums usually entail lower service charges or copayments, as well as lower deductibles per year.

4)    What is a Deductible?

A deductible is a fixed amount that you have to pay in addition to the policy’s premiums so that you can avail of your health insurance once the period starts. It is usually paid before the start of a fresh year and covered during the waiting period.

Paying low premiums for a health policy plan might involve a limited provider network as well as higher deductibles.

5)    Is Copayment Necessary?

A copayment, on the other hand, is the flat yet fixed amount that you have to pay with every routine visit to the doctor or while buying prescription medicine.

In other words, you are liable to pay a certain ‘service fee’ or ‘copayment’ once your yearly deductible has been taken care of.

6)    What is Co-insurance?

Coinsurance is the percentage of the entire cost of medical services that were incurred during care at the hospital.

Most health insurance companies require you to pay an 80/20 coinsurance where the policyholder has to pay 20% of the total medical bill.

The rest, that is, 80% of the bill is covered by your health insurance provider so that you do not have to worry about fleeting expenses during adversity.

7)    Does your Employer sponsor your Health Coverage?

Usually, most employers in America are tied up to policy providers that allow you to choose from several health insurance plans as per your requirements.

While the employer sponsors the premiums, you will have to pay the extra over-the-pocket costs to keep your insurance valid.

For instance, if you are choosing a health policy plan with a lower premium, you will not only have to pay a higher deductible but also a copayment surcharge whenever you avail of a service.

8)    Will I have a Provider Network?

We all have a physician whom we consider as a ‘part of the family.’ Imagine signing up for health insurance only to find out that your ‘family doctor’ is not included in your network of available hospitals.

Each healthcare policy has a set of hospitals and doctors tied up to their network. If a hospital is on the network, this means you can avail of the consultation service with the help of a copayment instead of the actual service surcharge.

Before choosing a health plan, make sure you are comfortable with the provider network and whether or not their service pricing is included in the insurance or not.

9)    Will I have Dental Coverage?

Most health insurance plans do not cover dental coverage of any sort, even if it is a routine check-up for cavities.

Despite the fact that dental procedures are over-the-top costly, its premiums are usually low and might entail higher premiums as well as high copayments whenever required. If you need regular dental visits, it is better to ask for a plan that includes dental coverage within your insurance.

10)  Will I have Pharmaceutical Coverage?

Prescription medicine usually has an extra copay that you will be liable to cover if it is included in your health insurance.

Contrastingly, a prescription medicine present on your insurance plan can cost you more money due to the copay, unlike a few dollars from before. It is better to inquire whether you will have to buy the generic medicine yourself, or cover the copay only.

Pharmaceutical coverage is, however, ideal for prescription medicine that is otherwise unaffordable, rare and expensive to acquire. People undergoing chemotherapy or taking immunosuppressants and antidepressants regularly can benefit from health insurance by paying only 20% of coinsurance and 30% of copayment.

The Final Verdict

The Patient Protection and Affordable Care Act was signed in 2010 to ensure that no US citizen is deprived of primary healthcare needs. But, controversy arose as many people believed the act to be a way to make the policymakers richer without providing access to care.

After the law came into practice, many uninsured American citizens acquired the privilege of getting access to affordable healthcare as per insurance policies and their quality of care.

As a result, the law welcomed massive reductions in uninsured American citizen rates by making health insurance a mandatory step for living in the States. Moreover, people living in rural areas have the privilege of acquiring healthcare within their vicinity that had limited access previously.