Five Questions to Ask About Health Insurance

As any businessperson knows, getting the most from your time and money often starts with asking yourself the right questions. It’s the same with insurance.

We’re the Utah Insurance Department and we’re here to help you with any type of insurance questions or problems.

If you want to find the right health insurance plan for your needs and budget, you also need to ask yourself the right questions. We suggest starting with these basic questions:

1. Will the out-of-pocket cost be affordable?

If you don’t maintain a cushion of funds in the bank, you may want a health plan with a low deductible. If you do have savings and can afford a higher deductible (if necessary), you may be able to find a plan with lower monthly payments. Also, think about how much you spent on health care last year. If you spent a lot, it’s important to know what you spent it on and if you expect to spend at the same pace next year. If they are recurring costs (for prescription drugs, or your favorite doctor, for example), make sure your plan covers these services. The best plan is to talk with your insurance agent. The agent will be able to help you choose a plan that will maximize your coverage at a rate that is affordable for you.

2. Who will be covered under this plan?

That may sound like a silly question. Obviously, you are most likely looking to have coverage for your dependents and you. But ask yourself: Does anyone in your family have other coverage options? Possibly with their employer? If so, they may not need to be on your plan.

3. What’s the deductible?

This is the amount you pay out-of-pocket for covered health care services before your insurance plan begins paying for services. For example, if your plan has a $2,000 deductible, you would pay the first $2,000 of medical expenses yourself. If you use an in-network provider, once you pay your deductible, you usually pay only a co-payment or co-insurance for covered services. Your insurance company will pay the remaining portion. A couple of things to keep in mind about deductibles:

  • Generally, plans with lower monthly premiums have higher deductibles and narrow provider networks. Plans with higher monthly premiums usually have lower deductibles and more providers to choose from.
  • Many plans pay for certain services, like an annual checkup, before your deductible has been met.
  • Some plans have separate deductibles for certain services, like prescription drugs.
  • Family plans often have both an individual deductible, which applies to each person, and a family deductible, which applies to all family members.

Talk with your insurance agent about your health insurance needs, and together you can decide on a plan that is best for you and your family.

4. What does the policy cover?

As you might guess, health insurance policies vary greatly in costs and what they will or will not cover. Most plans will cover at least a portion of the most important benefits, such as doctor visits, hospitalizations, prescriptions, maternity and infant care, and mental health care. Preventive care such as vaccinations, cholesterol screening, blood pressure screening, colorectal cancer screening, mammograms and pap smears are often covered as well. How much your plan will cover on any or all of these medical benefits depends on which plan you choose.

5. What questions should I ask my insurance agent?

Having an insurance agent can help you select the right plan for you and your family. Here are a few critical questions to ask your agent before selecting a plan:

What does my plan cover?

This is by far the most important factor in selecting a plan. And the answer can vary greatly. Make sure you know what your plan does and does not cover before selecting it.

How much does the plan cost?

When looking at the cost of health insurance plans, consider two main factors:

  • The premium. This is the amount you will pay the insurance company for your plan.
  • The out-of-pocket costs. This is the amount you will pay out of your own finances when you receive medical care.

Knowing the answer to this question is extremely important. It will determine whether your plan is affordable for you or not.

Can I keep my same doctor?

Most health insurance plans have a network of providers—doctors, hospitals, laboratories, imaging centers, pharmacies, etc. Each insurance company has contracts with these types of medical providers agreeing to provide services to plan members at a specific cost. If a doctor is not in your plan’s network, the insurance company may not cover the bill or may require you to pay a greater share of the cost. So if you have doctors you want to continue to see, make sure they are included in your plan’s network.

An insurance agent knows health insurance and can answer any question and allay any concerns you might have during this complicated process. If you don’t have an agent, check out our Licensee Search tool. Just enter your address to find an agent near you. And, remember, health insurance agents get paid by the insurance companies. There is absolutely no cost to you to get their advice and recommendations.