Updated: Aug 24, 2020
Many people feel overwhelmed when selecting a health plan, so it’s essential to be well advised and up to date. To help you get started, we’ll answer some of the most important questions to ask before buying health insurance.
How much will it be?
To make a long story short, the cost of your plan depends on three factors: its premium, deductible, and out-of-pocket max. Firstly, the premium is the amount of money you will need to pay each month to stay covered. Then, the deductible is how much you must pay before your insurance plan starts to pay for you. Finally, the out-of-pocket max is the limit on the amount of money you will pay for covered services.
For example, let’s say you need a procedure that costs $55,000, and the out of- pocket max is $5,000. After you spend $5,000 on the deductible and any copayments, your health plan will cover 100% of the remaining costs, provided that the procedure is done at an in-network hospital. The advantage of having insurance, even though you still must shell out some money out-of-pocket, is that you end up paying a negotiated rate, usually well below the full price.
Which tier is right for me?
The decision of which tier to choose depends on your personal needs. For example, if you are a person with complicated medical issues that require regular care or dependents, then a gold or platinum plan is probably the best choice. On the other hand, if you are a single person who enjoys good health and leads a healthy lifestyle, the bronze or silver tier could be a better fit.
Is my doctor covered?
You can review the provider directory to ensure your doctor and health care center is in-network and check if all your prescriptions or medical equipment are covered.
What about emergencies?
In the event of an emergency, you should always go to your closest ER or call 911. The hospital will talk to your health insurer for any authorizations they may need. Whatever the case, your emergency will be covered until you are in a stable condition, regardless of provider. However, if you require follow-up care at an out-of-network facility, it may not be covered. That’s why we always recommend that you get treated at an in-network facility.
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