Fee-for-Service Insurance
How much is the monthly medical insurance premium? What will
your total cost be each year?
What does the policy cover? Does it cover prescription drugs,
out-of-hospital care, or home care? Are there limits on the
amount or the number of days the company will pay for these
medical services.
Are you currently being treated for a medical condition that
may not be covered under your new plan? Are there limitations
or a waiting period involved in the coverage?
What is the deductible? Often, you can lower your monthly medical
insurance premium by buying a policy with a higher yearly deductible
amount.
What is the coinsurance rate? What percent of your bills for
allowable services will you have to pay?
What is the maximum you would pay out of pocket per year? How
much would it cost you directly before the insurance company
would pay everything else?
Is there a lifetime maximum cap the insurer will pay? The cap
is an amount after which the insurance company won't pay anymore.
Health Maintenance Organization (HMO)
Are there many doctors to choose from? Do you select from a
list of contract physicians or from the available staff of a
group practice? Which doctors are accepting new patients? How
hard is it to change doctors if you decide you want someone
else? How are referrals to specialists handled?
Is it easy to get appointments? How far in advance must routine
visits be scheduled? What arrangements does the HMO have for
handling emergency care?
Does the HMO offer the services I want? What preventive services
are provided? Are there limits on medical tests, surgery, mental
health care, home care, or other support offered? What if you
need a special service not provided by the HMO?
What is the service area of the HMO? Where are the facilities
located in your community that serve HMO members? How convenient
to your home and workplace are the doctors, hospitals, and emergency
care centers that make up the HMO network? What happens if you
or a family member are out of town and need medical treatment?
What will the HMO plan cost? What is the yearly total for monthly
fees? In addition, are there co-payments for office visits,
emergency care, prescribed drugs, or other services? How much?
Questions to Ask About a PPO
Are there many doctors to choose from? Who are the doctors in
the PPO network? Where are they located? Which ones are accepting
new patients? How are referrals to specialists handled?
What hospitals are available through the PPO? Where is the nearest
hospital in the PPO network? What arrangements does the PPO
have for handling emergency care?
What services are covered? What preventive services are offered?
Are there limits on medical tests, out-of-hospital care, mental
health care, prescription drugs, or other services that are
important to you?
What will the PPO plan cost? How much is the premium? Is there
a per-visit cost for seeing PPO doctors or other types of co-payments
for services? What is the difference in cost between using doctors
in the PPO network and those outside it? What is the deductible
and coinsurance rate for care outside of the PPO? Is there a
limit to the maximum you would pay out of pocket?