Ten Questions to Ask Before Choosing a Health Plan | Health Insurance Basics | Independence Blue Cross

Choosing the Right Plan

Ten Questions to Ask Before Choosing a Health Plan

Does the plan offer coverage for both in and out-of-network providers, or does it include a tiered or limited network?
Are my doctors and hospitals included in the network?
How much is the premium?
How much will I need to pay every time I receive care (cost-sharing or out-of-pocket costs)?
Does the plan include a deductible, and if so, what is the out-of-pocket maximum?
What preventive care services are covered with this plan and how much will I have to pay for them?
How much does the plan cover for hospital stays and inpatient or outpatient surgery?
Does the plan include coverage for prescription drugs and are there any special provisions, like a separate deductible or mandatory generic program?
Are my prescriptions covered under this health plan and how much will I pay for them?
Does the health plan include coverage for ancillary or specialty services like vision, dental, or travel insurance?

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Do I Need Other Types of Insurance?

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Definitioner

travel insurance: A type of insurance to help offset the cost of medical care when travelling or living abroad. Get more information on travel insurance.
premium: Sometimes called a monthly rate, it’s the set dollar amount you pay each month for health insurance.
out-of-pocket maximum: This is the maximum amount that you will have to pay for care during the plan year. This does not include your premium, just out-of-pocket costs, such as copays, deductibles, and coinsurance. Any care you receive after you meet your out-of-pocket maximum is covered 100 percent. For example, if your out-of-pocket maximum is $6,000 and you reach this amount, your health plan will cover any additional costs for covered services in full (some exclusions may apply; see your benefits for details).
out-of-pocket costs: Also known as cost-sharing, it’s the amount of money you pay for care, in the form of copays, deductibles, and coinsurance. This is in addition to the premium or monthly rate you pay to be a member of the health plan.
out-of-network providers: The doctors, hospitals, labs, and other health care providers who DO NOT have a contract with a health insurance company. Some health plans include coverage (at a higher cost) for out-of-network providers, and some may not provide coverage at all.
preventive care: Services that are intended to help you stay healthy and may also detect some diseases in the early stages. Examples include flu shots, mammograms, colonoscopies, and cholesterol tests.
deductible: The amount you pay each year before your health plan starts paying for services. For example, if your plan has a $1,000 deductible, you will need to pay the first $1,000 of the costs for the health care services you receive. Once you have paid this amount, your insurance will begin to pay a portion or all of your health care costs, depending on the plan.
cost-sharing: Also known as out-of-pocket costs, it’s the amount of money you pay for a health care service, in the form of copays, deductibles, and coinsurance . This is in addition to the premium or monthly rate you pay to be a member of the health plan.