Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like Reviews.com.

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Mar 19, 2020

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The lowdown...

  • Different policies may cover the cost of the same services at varying levels.
  • Co-pays and deductibles need to be factored into your budget along with the premium amounts.
  • Some policies have a limited list of providers that may or may not include your current doctors.

Perhaps the most important thing you can do when you are shopping for health insurance is to know what questions to ask. Without understanding the details of a policy you can become locked into a plan that won’t cover your needs or costs you far more than what you estimated.

Compare health insurance rates now by using our FREE tool above!

The following questions are some of the most important ones you should find the answers to before you enroll in any insurance plan.

What services are covered?

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Some policies may only cover preventative care such as annual physicals and blood work. This basic care is critical for everyone to maintain health and allow for early diagnosis of some issues.

However, if you know you require additional care – such as dermatology appointments or vision care – be sure to read the policy thoroughly to ensure that you can get the care you need. Basic policies must cover preventative care and treatment for urgent issues but may have limits on specialized care.

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What types of services are not completely covered?

Policies may cover different treatments at varying levels of payments. Under the Affordable Care Act, insurance companies may not exclude a person from obtaining coverage due to a pre-existing condition, however not all services will be paid at 100%. Exclusions or reduced benefits may apply in situations such as repeated treatment for particular conditions or selecting a provider out-of-network.

Does the policy have a list of providers that I must use? and
What happens if I use an out-of-network provider?

Often policies have a list of participating doctors, specialists, and facilities. These participating providers have agreed to specific payments from the insurance company and/or from the individual.

Using out-of-network providers often will put you in a situation where you will have to pay higher amounts than using an in-network provider.

For example: Dr. Smith is a preferred provider. He has agreed to provide preventative care 100% paid under your policy. You instead selected Dr. Miller who is out of network. Under your policy, a visit to Dr. Miller will cost you $20 per visit plus 10% of the cost of any tests.

What is the monthly premium?

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Along with the knowing what the monthly premium is, you will also need to know:

  • When is the premium due?
  • Can I pay on a different schedule such as quarterly or annually?
  • How may I pay my premiums?

Premiums are, of course, a critical part of your decision to purchase a policy. When you are researching your options, make sure you are comparing monthly premium amounts. Be sure to not be confused by a semi-monthly (twice per month) premium amount or a quarterly amount.

Some companies may allow you to pay your premiums less frequently if that better suits your budget. Be sure to review all of your options.

In the electronic world we live in today, we have so many different options in regard to how we pay our bills.

  • Automatic payments
  • Checks
  • Manually from our bank account

Some companies prefer that you pay via one particular method and may bill you an additional charge if elect a different method. Be sure to learn and understand if you are able to change your method of payment during the term of your policy.

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What costs am I responsible for – aside from premiums?

Your premium amount will, most likely, not be the only cost you will need to budget. Other costs may include:

  • Co-pays – the amount due at point of service
  • Deductibles – the amount of your costs you are responsible for before your policy will cover the charges

Factoring a total of all potential costs will help you make the best policy selection and avoid breaking your budget.

Shopping for healthcare can be a confusing experience. Patience and research are the best tools you can carry to make your shopping experience less stressful. No question is a dumb question when you are unclear about a policy, so ask the questions you need to have answered before you send in your first payment. Enter your zip code in our FREE tool below to compare health insurance rates now!