What does the plan pay for and what does it exclude?
Most health plans must include a standard set of benefits, also known as essential health benefits (www.healthcare.gov). They include services, such as maternity and newborn care, preventive services and prescription drug coverage. In addition, most plans cannot require pre-existing condition waiting periods.
Find out how the plan works
Consider:
- Do you have coinsurance or a copay, and if so, how much is it?
- How much is the deductible?
- How often will you have to pay out-of-pocket for copays or deductibles?
- 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 medical providers in the plan's network?
Find out 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?
To help you compare plans, use our health plan comparison form (PDF, 90.33 KB).