Questions to ask when comparing health plans

What does the plan pay for and what does it exclude?

Due to health reform, most health plans must include a standard set of benefits. These are called "essential health benefits (www.healthcare.gov)" and include services, such as maternity and newborn care, preventive services, and prescription drug coverage.

Find out how the plan works

Ask:

  • Do you have a copay, and if so, how much is it?
  • How much is the deductible?
  • How often will you have to pay the copays or deductible?
  • Are there limits on the number of times you can receive a service (lifetime maximums, daily, or annual benefit caps)?
  • Are your prescriptions on the list of covered drugs (also called the "formulary")?
  • Are some or all of your providers in the plan's network?

Ask if there are special requirements to get your care covered

For example:

  • Do you need prior authorization for some services? If so, how do you get authorization?
  • Does the plan exclude coverage for some types of care?

Due to health reform, most plans cannot require pre-existing condition waiting periods any more.

To help you compare plans, use our health plan comparison form (PDF, 98KB).

Updated 05/06/2014

See also

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