Questions to ask when comparing health plans
What does the plan pay for and what does it exclude?
Look for benefits such as:
- Preventive care
- Well-baby care
- Substance abuse
- Maternity care
- Chiropractic care
- Naturopathic care
- Mental health care
Due to health reform, most plans must include a standard set of benefits starting Jan. 1, 2014 or shortly after. These are called "essential health benefits (www.healthcare.gov)" and will include services, such as maternity and newborn care, preventive services, and prescription drug coverage.
Find out how the plan works
- Do you have a copay?
- How much is the deductible?
- How often will you have to pay the copayments or deductibles (per year, per occurrence)?
- Are there limits on the number of times you can receive a service (lifetime maximums, daily, or annual benefit caps)?
- Does the plan cover prescriptions?
- Are your prescriptions on the list of covered drugs (this is generally called the "formulary" list)?
- Can you see your provider?
Under health reform, starting Jan. 1, 2014, most plans must include in their standard set of benefits (www.healthcare.gov), services such as prescription drug coverage.
Ask if there are special requirements to get your care covered
- Do you need prior authorization for some services? If so, how do you get authorization?
- Are there waiting periods before coverage takes effect?
- Are some types of care excluded?
Starting Jan. 1, 2014, most plans can't impose pre-existing condition waiting periods on anyone. This rule is already in effect for children under age 19.
To help you compare plans, use our Plan comparison form (PDF, 163KB)