What you need to know before buying health insurance

What you need to know before buying health insurance

A) How much will I likely pay in TOTAL in the course of a year?
Your TOTAL cost is a combination of three things:

1) Your monthly premium payment, times 12 months for the entire year.
2) The annual deductible (this is the amount of medical expense you pay, starting in January of each year, before the insurance coverage ever kicks in).
3) The total of all the co-pays that you pay, during the course of the year, for doctor visits, hospital stays, tests, prescriptions, and other things. Of course, you can’t predict in advance how much this will be. But, based on your current health status, you can make a very rough guess of how many visits, treatments, and medications you might use in a year.

So, when you compare different insurance policies that you might buy, make a calculation for each of them based on the premiums, deductibles, and co-pays for an entire year. That will give you a basis to judge the DOLLAR VALUE of each policy you are comparing.

B) Are the doctors and hospitals that I go to covered?
Depending on the type of policy, you might have open access to most all providers, OR you might be restricted to using certain ones; OR you are not restricted, but you will have to pay higher co-pays if you go to certain ones rather than others.

C) Are the medications that I use covered?
Every insurance policy with drug coverage has a FORMULARY, which lists the drugs it covers. If you use certain medications, make sure to see if they are on the list or not. For drugs that are not on the list, what can happen, depending on what the policy says, is:
(1) You cannot get it covered at all. You have to pay full price by yourself; OR
(2) You can get it, but you have to
pay a higher co-pay; OR
(3) You have to try the substitute medication which is on the formulary, and if your doctor documents negative side effects, then the insurance company will
finally approve and pay for the medication you need even though it’s not on the formulary.

Here’s some good news:
Thanks to the Affordable Care Act (aka Obamacare), insurance companies, starting in 2014, can no longer deny coverage because of health conditions. Also: There are no more lifetime limits on how much a policy will pay out for a person; children up to age 26 can stay on their parents’ policy; and the premiums for older people can’t be more than 3 times that of young people.