Helpful Questions on Shopping for Health Insurance

Consider the following questions before shopping for health insurance.

Does the plan ...

  • Charge a premium in addition to the Medicare Part B premium?
  • Charge co-payments for doctor visits?
  • Pay for prescriptions? How much?
  • Limit the drugs it pays for to those on a specific list of drugs (called a formulary)?
  • Cover the drugs I use?
  • Charge more if I use a doctor or hospital outside the plan? How much?
  • Have maximum amounts it will pay for different services?
  • Set limits on what doctors and hospitals charge you?
  • Charge a deductible or coinsurance for inpatient hospital services, home health or skilled nursing facility services?
  • Cover routine physicals?
  • Cover eye exams, glasses and contacts?
  • Cover dental exams and treatments?
  • Cover programs that focus on helping members with specific, chronic conditions such as asthma, diabetes or heart conditions?

With the plan ...

  • May I use my regular pharmacy?
  • Are mail-order pharmacies available?
  • What is the annual or quarterly dollar limit on prescription drug coverage?
  • Will I have to pay more if I prefer to use brand name instead of generic drugs?
  • Is there a maximum out-of-pocket cost for prescription drugs? What is it?
  • Are the hours and location of its doctors, clinics and other health care providers convenient?
  • Is my access to emergency care convenient?
  • Are the doctors' offices, lab and other services convenient?
  • How fast can I be seen for urgent (non-emergency) care?
  • Is there a telephone hotline for medical advice?
  • Are my doctors in the plan?
  • Is there a selection of the doctors, health professionals and hospitals that I might need?
  • Can I get the doctor I want? Is he or she accepting new patients under that plan?