What should I ask about a health insurance plan?

Here are some questions to get you started.

  1. What hospitals and doctors are in the plan’s network? Make sure your primary care doctor is in network.  (As an example, a 68 y/o man who had a Medicare Advantage plan (HMO) was not able to get treatment at Johns Hopkins because the hospital was not in his plan's network)
  2. What is not covered (exclusions)?
  3. What are my copays for common services like office visits, x-rays, bloodwork and physical therapy?
  4. How much will the plan pay for brand and generic prescriptions? Is there any cap---meaning, the plan only pays for $5,000 per year in drug costs?
  5. What happens if I get cancer? Get pregnant? Become disabled? These are the biggies that really test insurance companies.
  6. Is there coverage for mental health outpatient services?  What is it?
  7. Are alternative or complementary therapies (like acupuncture and reiki) covered?

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.