Whenever you buy an insurance plan, you need to do more than just check which one’s the cheapest option. Comparing monthly premiums, deductibles, and out-of-pocket maximums is easy. But you need to understand the nuances that can make a big difference. Here are the things you should compare.
Primary care visits: If you’re healthy, then you may only need a check-up every few years and doctor’s visits when you catch a cold. Some plans offer copays as low as $20 for primary care visits; others make you pay full price before your deductible. Some have copays for limited visits and full price after too.
Network size: This is extremely important. You need to ensure that the hospitals around you are included in your insurer network. Otherwise, you may end up paying for insurance coverage and have to pay the hospital bill as well because you’re not close to any network hospital in your time of need.
HMO vs. PPO: An HMO requires you to select a primary care physician (PCP) and obtain a referral from that PCP before visiting any other healthcare provider. If you don’t have a referral, your insurance will deny all your claims. Your insurer could keep changing your PCP and then deny your claim. So read the fine print and be careful.
Ambulance and ER: Unless you have a top-of-the-line policy, a visit to the ER is the most expensive way to access healthcare. Include an ambulance, and you’ll be spending over $1500 per visit. With an average plan, you’ll spend more.
Mental health: If you have regular counseling or therapy sessions, choose a plan that lets you pay a copay for outpatient mental health visits. Bad plans make you pay the full bull before you meet your deductible.
Prescriptions: If you have ongoing prescription needs, ensure that your plan covers them. Most policies will make you pay full price for a branded drug if generics are available.
Pregnancy: Check hospitalization coverage and delivery benefits prior to signing up if you see this in your future.
Ideally, use an online comparison tool and enter specific medications you need to find a health insurance plan that’s best for you.