Topic Area:  

  • Getting health insurance coverage

What should I do before I buy health insurance?

Before you buy a health insurance policy, make sure you understand what you are buying.

What does it cover?

Most health plans cover a wide range of medical care - from wellness visits and prescription drugs, to hospitalization. Learn more. However, all health plans have a list of things they don't cover (called exclusions).

Ask for the Summary of Benefits and Coverage which will give you an overview of what the plan covers and what it does not cover. If you have a specific question about how the plan will cover services or prescriptions that you think you'll need, call the customer service number to ask.

Keep in mind that although two plans may cover the same service, they each may have different rules -- for example:

  • The plan may require you to get your care from a particular list of doctors (see below)
  • You may need to get certain services approved by the insurance company ahead of time, learn more or get a referral to see a specialist. Learn more.
  • There may be a limit on the number of times you can get that service in a year
  • You may need to try a less expensive treatment before the plan will pay for the more expensive one
  • One plan may require you to pay the full cost yourself until you reach your deductible; another may require you to pay only a co-payment.

What will it cost?

You pay for health insurance in two ways:

  • The monthly premium that you pay to purchase your plan.
  • The amount you pay out-of-pocket when you receive medical care -- the annual deductible, co-insurance, and co-payments.

You can learn more about the cost of care in our Managing Your Cost section of this guide.

Which doctors and hospitals are covered by the plan?

Every health insurance plan has a network of providers--doctors, hospitals, laboratories, imaging centers, and pharmacies that have signed contracts with the insurance company agreeing to provide their services to plan members at an agreed upon allowed amount, usually at a discounted rate.

If a doctor is not in your plan's network, the insurance company may require you to pay a higher share of the cost, or in some cases, it may not cover the bill.  So, if you have doctors you want to continue to see, you will want to find out if they are in the plan's network.

Helpful tips

  • Visit www.healthcare.gov, contact different insurance companies, or ask your licensed insurance agent or broker to show you policies from several companies so you can compare them and decide which one is best for you.
  • Carefully read and understand a policy before you sign up.
  • Make sure the policy states the date that the policy will begin paying (some have a waiting period before coverage begins), and what is covered or excluded from coverage.
  • Think about what is most important to you when it comes to your health insurance and the trade-offs that you are willing to make. Learn more.

4/10/2018