The 5 Questions You Must Ask Before Buying Health Insurance

Before deciding on your next healthcare insurance provider, there are some important questions you need to ask so you can confidently compare each plan and find one that checks all your boxes.

1.) What is the Deductible & Out of Pocket Costs?

In health insurance, both the deductible and out-of-pocket expenses are important terms that relate to the costs you may incur for medical services. Here’s an explanation of each:


A deductible is the amount of money you must pay out of your own pocket for covered healthcare services before your insurance plan starts to contribute. For example, if your health insurance plan has a $1,000 deductible, you would need to pay the first $1,000 of eligible medical expenses before the insurance coverage kicks in. Not all services may be subject to the deductible, so make sure to review your policy for specific details.

Out-of-Pocket Expenses:

Out-of-pocket expenses refer to the costs you are responsible for paying in addition to your premiums. These costs include deductibles, co-payments, and co-insurance. Once you’ve met your deductible, you may still have other out-of-pocket expenses. Co-payments are fixed amounts you pay for specific services (ex: $20 for a doctor’s visit).

There is usually a maximum limit on out-of-pocket expenses called the out-of-pocket limit. Once you reach this limit, your insurance plan typically covers 100% of eligible healthcare expenses for the remainder of the coverage period. This limit helps protect you from excessive financial burdens in the case of significant medical expenses.

2.) What Are Co-insurance Percentages?

When choosing health insurance, understanding co-insurance percentages is how you can assess your potential out-of-pocket costs. Co-insurance is the percentage of covered medical expenses that you are responsible for paying after meeting your deductible. It represents your share of the costs, with the insurance company covering the remaining percentage. 

When comparing health insurance plans, look at the co-insurance percentages and other cost-sharing details. Plans with higher co-insurance percentages generally have lower monthly premiums but may result in higher out-of-pocket costs when you need medical care. Conversely, plans with lower co-insurance percentages may have higher premiums but lower out-of-pocket costs.

3.) Is My Rx Medication Covered?

Find out if the health insurance plan provides coverage for your prescription medications. You can do this by searching the plan’s formulary, which is a list of prescription drugs covered by the insurance. It typically categorizes medications into different tiers, with different cost-sharing arrangements for each tier. Make sure your necessary medications are included in the formulary.

4.) Does It Have Out-of-Network Benefits?

Out-of-network benefits provide coverage for healthcare services received from providers who are not part of the insurance plan’s network. Understand the cost-sharing arrangement for out-of-network services. Plans may have higher deductibles, co-payments, and co-insurance for out-of-network care. 

5.) Does Your Current Doctor Accept It?

Reach out to your current doctor’s office and ask whether they accept the specific health insurance plan you are considering. They can provide you with information on their participation in different insurance networks.

Get Prepared With Benistar

By asking these questions and carefully reviewing the details of insurance policies, you can make informed decisions that align with your needs and provide the coverage you require. Reach out to the experts at Benistar who can help create healthcare plans for retirees at (860) 408-7000.

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