Health Insurance: Top 10 questions to ask

Health insurance options got you overwhelmed? Don’t be discouraged.

While it can sometimes seem like shopping for health insurance is about as easy as getting across the Twin Cities during rush hour, it’s important to know both your options and how you’ll choose among them.

That’s why we’ve created a list of ten questions to ask when picking health insurance plans. These questions can help you sort through different plan details to find the right choice for you, your family, your health and your budget. Think of it as your personal “health insurance GPS.”

With this information in hand, you’ll be ready to compare health plans with confidence and get closer to finding an option that checks all your boxes. Whether you’re picking a plan for the first time – or thinking about changing health insurance plans – these are good questions to ask yourself.

1. Will this health insurance plan help me save money if I’m healthy?

Imagine that, under the plan you’re considering, you and your family have a good health year: You go to the doctor a few times for checkups, your partner takes a couple prescriptions, the kids visit urgent care a couple times

– and that’s about it.

If you don’t expect to use your plan that often, pay close attention to recurring costs to see if there’s an opportunity to save money. But remember: It’s impossible to fully plan for the unexpected, so be sure to also factor in the cost of getting care if (and when) you need it.

Related questions to ask:

  • How much will I pay each month (monthly premium)?
  • How much will I pay to see my doctor, visit urgent care, go to the emergency room or fill prescriptions (copays)?
  • If I get the same care as last year, what would it cost?
  • Does the bottom line fit my budget?

2. Will this health insurance plan be affordable if I’m sick?

Now imagine the opposite scenario, where you use your plan a lot: You come down with an infection and need to stay in the hospital for a few days, your partner’s prescription list grows, the kids break a few bones at practice on top of getting strep in the fall – and more.

It’s always hard to see situations like this coming, so it’s wise to be sure that your plan makes care affordable if you need to use it. In the end, you’ll want to aim for a good balance between expenses you can plan for (like monthly premiums, deductibles and the out-of-pocket maximum) and ones you can’t (like copays or coinsurance you pay only when you need care).

Related questions to ask:

  • How much will I have to pay before the plan starts to help (deductible)?
  • What’s my share of the cost of other care, like getting an X-ray or staying in the hospital (coinsurance)?
  • What’s the most I’d have to pay for care next year (out-of-pocket maximum)?
  • Could I afford the out-of-pocket maximum if I had to pay it?

3. Are my doctors covered by this plan?

Health insurance companies work with different doctors and clinics to help you get the best deals on your care.

Getting care from a person or place your plan covers saves you money. On the other hand, getting care somewhere else may mean your health plan pays less, leaving you with bigger bills. That’s why you’ll want to check that the doctors and clinics you expect to visit will be covered by the health insurance plan you’re considering.

Related questions to ask:

  • How big is the plan’s coverage network? What kind of network is it?
  • Is my current doctor covered by this plan (are they in-network)?
  • How much will I pay if I see a doctor who isn’t covered by this plan (out-of-network)?
  • Do I plan to get out-of-network care? Am I willing to switch doctors or locations if the ones I want aren’t in-network?

4. What is this health insurance plan’s prescription drug coverage like?

According to Georgetown University, two-thirds of all adults in the United States use prescription drugs, so there’s a fair chance you will, too (if you’re not already).

It’s not unusual for people to get so focused on the medical details of their health insurance plan they forget to look at the prescription drug coverage. These costs can add up, so be sure to review the plan’s formulary (drug list).

The formulary will tell you which drugs are covered and how much they’ll cost. That way, you can better plan your budget for any current drugs you’re taking (and any future ones you might need, like antibiotics).

Related questions to ask:

  • How much will I pay for my regular prescriptions? Are they affordable?
  • Do I need my health plan’s approval for any prescriptions before I fill then?
  • Which pharmacies are in-network? Are their hours and locations convenient?
  • What are my options if my prescriptions aren’t covered?

5. Will this health insurance plan make it easy to get care if I’m sick?

Waking up with a sore throat or sinus infection is never fun. When it happens, you want to feel better and find care – fast.

Everyone gets sick from time to time, so before it happens, consider how easy your plan makes it to find covered care. With this information in mind, you’ll know where to go and what to do as soon as you feel the first inklings of illness coming on.

Related questions to ask:

  • Do I have to pick one primary clinic or doctor I always go to first?
  • Are there covered urgent care clinics or emergency rooms nearby?
  • Does the plan cover virtual care options?

6. Will this health insurance plan make it easy to get care if I’m well?

Remember: health care is health care. To make the most of your plan, you’ll want to investigate what kind of benefits it has not only when you’re sick but also when you’re already well.

With a better sense of how your health insurance plan will help you keep feeling your best, you can save a few trips to the doctor’s office (and probably a few bucks, too).

Related questions to ask:

  • Are there free services to keep me healthy? Which ones are important to me and my family?
  • Will I pay anything for regular checkups, annual OB-GYN visits or routine tests?
  • Will I pay anything for regular immunizations, like a flu-shot?

7. If I’m interested in alternative therapies, how does this plan’s coverage work?

See a chiropractor? Planning to have your baby at home? Curious about acupuncture?

Different health plans treat alternative therapies (alternative medicine) different ways. In some cases, you’ll be covered the same as any other care. In other cases, you’ll only be covered a little or not at all. If this kind of care matters to you, take a close look at your plan’s benefits.

Related questions to ask:

  • How much do alternative therapies or services cost?
  • Is there any kind of cost-sharing for alternative medicine?
  • Do I plan on using alternative therapies often? Am I comfortable using other treatments instead?

8. Are there extra perks and benefits that come with this plan?

Health insurance plans aren’t all about numbers, medical coverage and drug coverage. Oftentimes, there are additional perks and benefits that can really help you improve your health or save money.

For example, will you have access to health coaches? Will you get a discount on your gym membership, or at the grocery store? Are there visits to a virtual clinic, at no cost to you? Dig into the options – you may find welcome some surprises.

Related questions to ask:

  • Does this plan offer any extra benefits that other plans don’t?
  • Will I actually use these additional perks? Which ones do I care about?

9. Will this health insurance plan still be right for me if my needs change?

Sometimes it’s expected and sometimes it’s not – but life changes, and so does what you need from your health plan.

If you know how your plan can grow with you, it’s easier to make a decision you’re comfortable with from the start. That way, you’ll have a good understanding of how different changes will affect your and your family’s coverage.

Related questions to ask:

  • What happens if I move or get a new job?
  • If I have a baby or decide to adopt, how will the child be covered?
  • What if I or someone in my family develops a serious health condition?
  • Am I expecting any big life changes in the next year or so?

10. Is it easy to get support and advice with this plan?

Health care can be complicated, so it’s not unusual to have questions about using your insurance or getting care.

Whether it’s when you’re signing up, searching for clinics near your vacation rental or wondering if you need to get care at 3 a.m., it’s vital to find a plan that makes member support easy and straightforward.

Related questions to ask:

  • Can I call a 24/7 nurse line whenever I have a health question?
  • Who will I call if I have a question about my insurance? When are they available?
  • Are there people available to help me and my family pick the right plan?
  • Will I know how to get in touch with the right people when I need to?

Getting answers to health insurance questions

In the end, health plans aren’t one-size-fits-all. You’ll want to talk to someone who can help match your unique needs with the plan that suits you best.

At True Texas Benefits, we help people in Texas find the right plan with the right coverage. We specialize in making things simple. And when things are simple, picking a health insurance plan feels less like being lost in the city and more like cruising down an open road.