Five questions to ask to find the right health plan

When selecting a health plan, there’s a lot to consider — and cost shouldn’t be the only one. It’s also important to find coverage that meets your needs. Now that open enrollment has started, refer to this checklist of questions as you consider a health plan for next year:

1. Am I clear about what health services the plan will cover? Coverage can vary, and it’s important to know the specific details of different plans. Most traditional health care plans must cover the same basic services — such as preventive care, hospital care, mental health care and maternity care. However, some services, like dental and vision, may not be fully covered. Take time to write down your health care needs, so you can understand the care and services you’ll require and then find health plans that offer these options.

2. Will the plan cover all the medicines my doctor prescribes? Your medications are an important consideration in your plan choice. Pharmacy coverage varies from plan to plan, and you will want to research whether your medications will be covered. Some insurers, like SelectHealth, provide pharmacy coverage information and prescription search tools on their site, allowing you to review the pharmacy benefits available.

3. Will I be able to keep my current doctor or hospital? You’ve spent time finding the right doctor to help you along your health journey. It can be stressful to find a new doctor if your current one doesn’t participate in your plan’s networks. Be sure you understand the option for out-of-network benefits if you want to keep your same provider but need to switch plans.

4. What are the premiums, copays and deductibles? Premiums are the amount you pay for health insurance. Copays are what you pay when you receive a medical service or fill a prescription. Deductibles are what you must pay before your insurer pays anything for a claim. In some instances, the deductible will not apply to certain services, but a copay is required. As you review different health plans, you should be able to see the estimated amount that you’ll pay for each of these. Consider your health needs because you may benefit by switching to a different plan design. For example, high deductible health plans often have lower premiums and allow you to contribute to a health savings account.

5. What is the most I’ll have to pay out of pocket? Many plans require you to pay a certain amount before they will start to pay for your care. Some plans have limitations on what out-of-pocket costs you’ll pay each year. Knowing your financial commitment required for each health plan helps you gauge your monthly and even annual health care and insurance expenses. You’ll want to assess your financial status along with your health needs to avoid falling into medical debt that may come from a high out-of-pocket amount.

These five questions will hopefully help you not only understand your health care needs, but help you feel more confident in selecting a plan for next year.

David Lemperle is chief sales and marketing officer, VP of SelectHealth, a not-for-profit health plan serving southeast Idaho members committed to helping people live the healthiest lives possible.