Healthcare Education

Five Questions to Ask When Comparing Health Insurance Plans

Whether you’re going from private insurance to Medicare or just trying to find a plan that works for you, navigating the complexities of health insurance can be overwhelming. Should I go with a PPO or an HMO? High deductible or high premiums? And how do I make sure all my medications and specialists are covered?

As Health Insurance Information Coordinator at Washington Hospital, my job is to help make this process a little easier – or at the very least, a little less intimidating. A free and unbiased service provided to district residents, I work with my clients to help them find the information they need to make an informed decision when choosing a plan that fits their medical needs, lifestyles and incomes. We do our best to ensure that no one goes without health care just because they’re uninsured or inadequately insured.

When evaluating plans, here are a few things one should ask:

Are my preferred doctors, hospitals and pharmacies in the provider network?

People are most likely to seek medical treatment when they know it’s covered. That’s why it’s important to make sure your preferred providers, hospitals and pharmacies are in-network – otherwise it may require additional out-of-pocket costs.

How much will I pay for coverage?

Whether you use your coverage or not, you have to pay a premium to your insurance company each month in order to stay insured. This is the base cost of coverage that doesn’t include co-pays, deductibles or out-of-pocket payments for services not covered by your insurance. So it’s important that your monthly premium fits within your budget and covers enough to not cause financial strain should you require medical services.

How much will I pay before my insurance kicks in?

A deductible is how much you have to pay for health care services before insurance takes over. For instance, if you have a $2,500 deductible, insurance will not pay for most covered services until you’ve paid $2500 directly in medical costs. These can include anything from a sick visit to prescriptions, depending on the plan. Typically, plans with higher deductibles come with lower monthly premiums, while higher monthly premiums mean lower deductibles. What you choose should depend on your financial situation and ability to pay money for care up front should a medical emergency arise.

What additional costs should I consider?

Even after you’ve met your deductible, you may be responsible for additional out-of-pocket costs like co-insurance (a percentage of the cost of a covered service or medication) or co-payment (a flat fee for a covered service or medication).

Are my prescriptions covered?

What medications are covered depends on your insurance plan and are often divided into tiers that determine how much you must contribute out-of-pocket to obtain them. If you have a regular prescription that happens to not be covered, you can petition your insurance provider to obtain coverage, but it’s a lengthy process with results that aren’t guaranteed. Before meeting with clients, I have them write out every medication they take so they’re not blindsided by out-of-pocket costs or left out in the cold if something isn’t covered.

For better or worse, health insurance is peace of mind, financial security and better health outcomes. Research shows that uninsured people have higher mortality rates, receive less timely care and are more likely to go into debt to pay for medical emergencies. They’re also more likely to die prematurely from treatable conditions. Frankly, to go without it is taking a serious gamble with your future.

Rather than forgoing or living with inadequate coverage, you can choose a plan that makes sense for your budget and needs. And knowing what to ask and what to look for is a great place to start.

To learn more about Washington Hospital’s Health Insurance Information Service visit www.whhs.com/health-insurance .