Whether deciding on Medicare coverage, a plan under the Affordable Care Act, or even which family member’s healthcare plan to join, there are several important definitions to know and questions to ask when choosing a healthcare plan.
First, it’s important to know the basics, including costs for various items. Here are some of the biggies:
• Premium: Amount paid regularly throughout the year for coverage.
• Deductible: The amount patients cover themselves before coverage kicks in.
• Copay/coinsurance: The patient’s share of costs on an individual medical bill.
Next, there are some questions you might want to consider:
• Which doctors or medical providers can I use under this policy? Will I be able to use my current doctor?
• Are prescription drugs covered? What about vision and dental care? How about hearing coverage?
• Will conditions that are important to me (for example, physical therapy, psychiatric care, nursing home care) be covered?
• What are the specific items and services the policy covers? What specifically won’t it cover?
• Does the policy have any exceptions or limits?
• Do I need to get prior approval or fulfill other requirements before I can receive coverage for certain procedures?
• Will I be covered if I travel to a different state or country?
• How and when can I renew or cancel the policy?
• What is the process for handling disputes over claims? How can I challenge a denial of coverage for a certain service?
Things to Consider:
- Carefully consider what coverage best meets your budget, lifestyle, and medical needs.
- Save this checklist for when it's time to review your healthcare options.
- Check out the national nonprofit Transamerica Center for Health Studies for additional resources.
Transamerica Center for Health Studies® is a division of Transamerica Institute®, a national nonprofit private foundation. The institute is funded by contributions from Transamerica Life Insurance Company and its affiliates and may receive funds from unaffiliated third parties. This material is provided for informational purposes only and should not be construed as ERISA, tax, or legal advice. TCHS and its representatives are not registered brokers, navigators, applicant assistors, or promoters.