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Are
you currently being treated for a medical condition that may
not be covered under your new health insurance plan? Are there
limitations or a waiting period involved in the coverage?
What is the deductible? Often, you can lower your monthly
health insurance premium by buying a policy with a higher
yearly deductible amount.
What is
the coinsurance rate? What percent of your bills for allowable
services will you have to pay?
What is
the maximum you would pay out-of-pocket per year? How much
would it cost you directly before the health insurance company
would pay everything else?
Is there
a lifetime maximum cap the insurer will pay? The cap is an
amount after which the health insurance company will not pay
anymore. This is important to know if you or someone in your
family has an illness that requires expensive treatments.
Questions
to Ask About an HMO
Are there
many doctors to choose from? Do you select from a list of
contract physicians or from the available staff of a group
practice? Which doctors are accepting new patients? How hard
is it to change doctors if you decide you want someone else?
How are referrals to specialists handled?
Is it
easy to get appointments? How far in advance must routine
visits be scheduled? What arrangements does the HMO have for
handling emergency care?
Does the
HMO offer the services you want? What preventive services
are provided? Are there limits on medical tests, surgery,
mental health care, home care, or other support offered? What
if you need a special service not provided by the HMO?
What is
the service area of the HMO? Where are the facilities located
in your community that serve HMO members? How convenient to
your home and workplace are the doctors, hospitals, and emergency
care centers that make up the HMO network? What happens if
you or a family member are out of town and need medical treatment?
What will
the HMO health insurance plan cost? What is the yearly total
for monthly fees? In addition, are there co-payments for office
visits, emergency care, prescribed drugs, or other services?
How much are they?
Questions
to Ask About a PPO
Are there
many doctors to choose from? Who are the doctors in the PPO
network? Where are they located? Which ones are accepting
new patients? How are referrals to specialists handled?
What hospitals
are available through the PPO? Where is the nearest hospital
in the PPO network? What arrangements does the PPO have for
handling emergency care?
What services
are covered? What preventive services are offered? Are there
limits on medical tests, out-of-hospital care, mental health
care, prescription drugs, or other services that are important
to you?
What will
the PPO health insurance plan cost? How much is the premium?
Is there a per-visit cost for seeing PPO doctors or other
types of co-payments for services? What is the difference
in cost between using doctors in the PPO network and those
outside it? What is the deductible and coinsurance rate for
care outside of the PPO? Is there a limit to the maximum you
would pay out of pocket?
 
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