What should I ask before purchasing a health insurance policy?

Diana Meeks
Diana Meeks on behalf of Sigma Nursing
Family Practitioner

Information overload can be a problem when you begin to research your health insurance options. Knowing what to ask an insurance provider or agent is important to getting just the right plan to meet your needs. Consider asking about deductibles and out-of-pocket expenses for office visits, emergencies and medicines. Compare actual benefits. Are there any caps on how much can be spent per individual or family? What are the exclusions for pre-existing or chronic conditions? Preparing a list of questions may prove useful.

Dr. Michael Roizen, MD
Internal Medicine

There are thousands of health-insurance companies, and your policy is only as good as that company; in other words, a fantastic plan from an irresponsibly run or near-bankrupt insurance company is worth about as much as the Sears Tower deed you bought from that fellow behind the bowling alley. Be a sly detective and find out if the company is shady or sinking before you entrust your life and sacred fortune to it. Once the company checks out, apply your detective powers again to carefully review the specific policy. To give your policy the third degree, ask:

  • What hospitals and doctors are in the plan’s network? Are the hospitals Joint Commission-accredited?  Check this again to make sure that the Dr. Frank you circled in the book is indeed your Dr. Frank.
  • What’s not covered?
  • Will I have continued care on my pre-existing conditions list? What will happen if I get cancer, get pregnant, or become disabled?
  • Can I use an out-of-network doctor, and what will it cost?
  • What percentage of the total cost will I pay for common services and diagnostic procedures such as X-rays or blood tests?
  • If I get extremely sick, how much freedom does my doctor have in coordinating care, and can I see any specialists I want?
  • How much will the plan pay for generic and brand-name prescription drugs?
  • Can I increase my deductible and pay lower premiums?
  • What’s the yearly out-of-pocket limit? (A typical figure is $2,000…don’t let them gouge you!)
  • What’s the maximum lifetime benefit? (It should be at least $5 million -- don’t let them be stingy.)
  • What is the coverage for mental health?
  • What’s the coverage for alternative therapies, such as chiropractic visits and acupuncture?
  • Will follow-up care, such as nursing-home or home-health care, be covered?
  • If I have a serious medical problem, will the plan provide someone to oversee care and make sure my needs are met?
  • Which specific conditions or injuries does the plan deem as emergencies requiring urgent care?
  • If I’m in a foreign country and have an emergency, will this plan pay to evacuate me at my request? (This one isn’t a must, but it’s a nice bonus -- plus, it can’t hurt to mention that you’re accustomed to flying first class.)
  • Do I need preapprovals for getting care and how difficult is that process?

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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.