What to look for in a Health Insurance

If you obtain your health insurance through your employer; you usually don’t have a lot of choices to make or worry about. You have to either take it or leave it.

However, if you are getting your own health insurance policy, here are a few things to look for:

1) Doctors and facilities. Does the insurance company require that you ONLY use their doctors? Is your doctor affiliated with the company? Are you willing to switch doctors; if they aren’t? Do you have to pay a larger share or 100%, if you seek treatment at a facility or doctor that is not part of the insurance company’s network?

2) Copays – yes or no? Do you want to know that your prescriptions and office visits will be a set amount or are you willing to have those smaller items count toward your deductible in order to get a lower rate?

3) Benefits – what doe the policy cover? Does it cover routine annual checkups or only illnesses and accidents? Does it cover all prescriptions or only certain categories of prescriptions? What about vision, dental, chiropractors, acupuncture, etc?

4) Pre-existing conditions – insurance companies do have some conditions that they will not cover; no matter what. Other conditions are treated differently by different companies. Some companies will charge extra; but, they will cover the condition fully. Other companies may waive that condition for a set period of time (1 – 5 years) or permanently (forever). Some will accept conditions; if, you are willing to accept a higher deductible. Some will accept a condition that has not reoccurred within a specific period of time after it has been surgically corrected (cancer 5 – 10 years depending on the company). So, if you do have a pre-existing condition; shop around. Only a few conditions are denied by all companies.

5) Deductible – how large of a deductible can you afford? If something bad happens, can you afford to pay the hospital $5,000 or $10,000 up front or is $500 or $1,000 more like it? Higher deductibles do mean lower premiums; but, they can be disastrous for some people; especially if they have to be paid 2 years in a row. Some people are willing to pay more premium in order to eliminate the deductible all together.

6) Co-insurance – this is what you still have to pay AFTER your deductible is met. Your share can be zero or as much as half of the next $10,000. The more your share is, the lower your premiums will be. But, in an emergency, can you afford to pay your share?

7) Premiums and Rate Guarantees – you need a premium you can afford, not just this year; but, in the future too. Some policies have NO rate guarantee; others will guarantee the rate will not increase for 1 year – 3 years. After that, the question is how often will the rate go up: annually or semiannually; on your birth month or once every 5 years for age related increases? A lot of people end up with very “rude awakenings” after their rate guarantee is up.

8) Claims – How well do they pay claims? Do they pay without question or do they question every time you see a doctor or have a test run? Do they routinely deny claims and then their customers have to appeal each denial? Do the doctors have to repeatedly send bills to the company or are they paid the first time on time?

These are all things you need to consider when getting health insurance. You can find the answers to these questions by: asking the insurance agent, checking the insurance company’s web-site, asking other people about their health insurance policy, and checking for complaints with the Better Business Bureau and other consumer organizations.

And, remember, if one company does not have a policy that meets your needs; keep looking. There are literally hundreds of companies out there with a lot of different variations on policies, premiums, and underwriting.