Five Questions to Ask When Comparing Health Insurance Plans
Author: Kristi Caracappa
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
Posted September, 2018
About Kristi Caracappa
Kristi Caracappa is the Health Insurance Information Service Coordinator
at Washington Hospital Healthcare System. She provides community members
confidential services to help them make informed decisions about health
insurance. The free health insurance information services are offered
year-round and have been noted by community members as instrumental when
making insurance decisions that impact the lives of entire families. Kristi
is a regularly featured speaker at community Health & Wellness seminars
focused on a variety of health insurance topics. She has held this position
since 2009. She enjoys serving residents of the Washington Township Health
Care District, where she and her family reside.