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?