Five questions to ask when choosing your health coverage
Find the right amount of coverage at the right cost by asking yourself these questions
1. Who will your health plan cover?
The more people covered by your health insurance, the more likely someone will need routine or unexpected care. If you only need coverage for yourself, and you’re young and healthy, you may prefer a high-deductible health plan. But you might want a different plan if you need to cover your partner and/or children.
List all the people your health insurance needs to cover and any expected medical needs (yours or theirs) during the coming year.
2. Are there specific providers you want to see or facilities you want to use?
If you’re considering switching plans and you already have a favorite doctor, clinic or hospital, it’s important to make sure they are part of the new plan’s network. Otherwise, you could end up paying much higher out-of-pocket costs than anticipated.
Check that plan’s online directory (or call their customer service number) to verify that your preferred provider is in-network.
3. Will your plan cover the medical care you need?
All health insurance plans have a predetermined list of services that they will partially or fully pay for (covered services).
Find out whether a potential new plan covers known medical expenses for you or your family members. These include monthly prescription drugs, ongoing visits for a chronic condition, home medical equipment, behavioral health needs and planned surgical procedures.
4. How much can you afford to pay?
You know your budget better than anyone. So, look carefully at a plan’s monthly premiums, annual deductibles, co-pays and co-insurance fees. You want to make sure that you won’t have to pay for a high deductible or other out-of-pocket expenses you can’t afford if the unexpected happens.
5. Do you want flexibility in choosing certain specialists or services?
For many people, one of the biggest health insurance decisions is whether to enroll in an HMO or PPO. Both types of plans use a network of contracted providers and facilities. But there are differences in how you can use that network.
In most HMOs, you select a primary care provider (PCP) who coordinates all your care, including referrals for specialist visits and certain procedures.
With most PPOs, you can self-refer for specialty care; there are fewer restrictions on who you can see. Generally speaking, the flexibility of a PPO comes with a higher monthly premium.
Lastly, ask if the plan includes care with UW Medicine.