Health insurance coverage is a necessity, but choosing between the plans can be confusing. Figuring out what you’d pay in total during the year can be even more confusing. Finding health insurance can take some time, and you can help the process move more smoothly by asking some important questions before you choose a plan.
How Much Can You Pay Per Month vs. Per Visit?
Likely the most important question for most people is about the cost of the plan. You’ll pay a premium every month or every quarter, you’ll have co-pays and co-insurance, and then there may be uncovered costs. You’ll also have different deductibles to fill as well as the out-of-pocket maximum.
If you can’t pay much per month and rarely visit the doctor, then your co-pays will be low in terms of yearly totals. A plan with a lower premium would work, although those plans often don’t have a lot of coverage. If you know you’ll be seeing the doctor a lot during the year, you may want a plan with a higher premium but much better coverage and very low per-appointment costs.
Do You Want to See Specialists Without Seeing Your PCP?
If you have an HMO for your insurance plan, you’ll have to see your primary care provider to get a referral every time you need to see a new specialist or see a specialist for something new. Specialists do have “follow-up” appointments that let you schedule directly with them for issues that they’re already treating you for. But if you find something new, then you may have to see your PCP for a referral.
That can be annoying for people, especially if they have a large co-pay that they need to hand over at each appointment. If you’d rather see a specialist directly, you’ll want a PPO, which allows you to skip the primary care appointment and referral if you already know which specialty you need to go to. PPOs can be more expensive than HMOs, though, so be aware of all the costs you’d have to pay if you bought a PPO policy. It helps to make some side-by-side charts and compare what you’d pay per month along with your co-pays in different situations with different types of plans.
Does the Plan Cover Your Doctors and the Medications You Need?
Finding a new doctor is not fun. You end up spending money to meet with doctors who may or may be a good fit. The search can go on for a while, and with so many doctors already seeing a lot of patients, it can take a while to get those appointments to begin with.
So being able to continue seeing your current doctor and the same specialists you already go to is another important question to ask. Is everyone covered? Is your doctor covered but the specialists aren’t? Are only a few specialists covered? You may want to call the billing departments at their offices and double-check if they take that insurance. Sometimes insurance company databases of doctors aren’t complete, or the information is out of date. Once you find out which policies cover who, you can narrow down the number of potential companies to choose from.
Get Assistance From A Health Insurance Broker
If you’re still having trouble finding a good health insurance plan, contact Margolis & Associates. We can help you sift through plans and find ones that work. Our brokers know which companies offer plans that may not get much attention, and we can figure out which are the most appropriate plans for you. Contact Margolis & Associates when you want to speak with a health insurance broker in Westchester County about NYC health insurance plans.