Questions to ask before choosing a health plan

Ask for something you can compare

A Summary of Benefits and Coverage, or SBC, presents key costs and coverage features in a standardized format. Ask for it when comparing plans that provide one, along with the policy documents that describe exclusions and limits. If an option does not have an SBC, ask what kind of product it is and which documents explain its benefits. Official source ↗

What does the network label tell you?

HealthCare.gov describes a PPO as a plan with participating providers and different costs for using providers outside that network. For any plan you consider, verify the actual provider directory and out-of-network terms. The initials alone do not answer every question about what the contract pays. Official source ↗

Use this checklist for each plan

• What is the full name of the insurer, product and plan?
• What kind of insurance is it, and what is its intended purpose?
• What is the monthly premium?
• Which deductibles, copays and coinsurance apply?
• Is there an out-of-pocket maximum, and which expenses count toward it?
• Are my doctors, hospitals and pharmacies in the exact network?
• Are my prescriptions covered, and under what conditions?
• What exclusions, benefit caps, waiting periods or approval requirements should I understand?
• What changes if I need care away from home?
• When does coverage begin, and how do I confirm it is active?

Example: the cheaper monthly payment

Imagine one option has a lower premium but a larger deductible and different covered services. Put the premium, likely care costs, potential high-cost year, network and exclusions side by side before deciding. The lowest monthly payment may not be the lowest overall cost for your situation. This is a comparison method, not a savings estimate. Official source ↗

Leave room for unanswered questions

Mark anything that needs confirmation instead of filling the gap with an assumption. Ask the insurer or broker to point you to the relevant document. Keep the final documents with your comparison so you can revisit how you reached the decision.