What Factors Are Important to Know When Buying Health Insurance?

Choosing the right health insurance plan can lower your medical expenses.

Choosing the right health insurance plan can lower your medical expenses.

Whether you get your medical coverage through an employer or on your own, you can save money in the short and long term when you compare plans. By taking the time to consider key factors before buying health insurance, you can also avoid having claims denied. Additionally, you can take advantage of basic, preventive and emergency coverage options that are offered by many plans and may be required by law in some cases.

Premiums and Health Insurance Deductibles

Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) -- which typically limit you to certain health care providers, or make your providers adhere to pre-negotated prices, or both -- offer lower health insurance premiums than do traditional plans that simply pay your providers whatever they charge, according to USA.gov. Be sure to compare lifetime maximum coverage limits. Some plans only cover you and your family members up to a certain dollar amount, while other plans offer unlimited coverage. Prior to buying health insurance, you should also compare monthly premiums based on deductibles. Although a higher deductible might lower your monthly premiums, it could raise your out-of-pocket expenses should you need to receive medical care.

Co-Payments for Physician Office Visits and Prescriptions

Co-payments for medical visits vary by provider. Review co-payment costs for visits to your primary care physician, specialists and emergency rooms. Frequent doctor visits -- such as the regular visits you might need for a pregnancy -- can increase out-of-pocket insurance costs if you choose a plan with high co-payments. Additionally, compare plan prescription co-payments, and check to see if you can receive prescriptions at reduced rates if you use generic prescription drugs.

Preventive Care

Check with health insurance providers to see if they offer preventive care at no additional cost to you. For example, some providers might let you receive blood pressure screenings, immunization vaccines, an obesity screening and counseling, mammogram and cholesterol screenings at no additional cost. If you have children between the ages of 18 and 24 months -- or if you plan to in the near future -- your provider might also let your child receive an autism screening at no cost to you.

Doctors in Plan

Confirm whether you can continue to receive medical care from your current primary physician or another physician of your choice. Health insurance provided through HMOs and PPOs might require you to receive all of your medical care from member physicians associated with their plans. If your physician is not a member of their plans, you might have to pay for medical care you receive from your physician out-of-pocket. Also, verify that the offices of physicians in plans are open on days and hours that are convenient for you and your family.

Pre-Existing and Special Medical Conditions

Review coverage options for health insurance plans to confirm that pre-existing medical conditions are covered for you and your family members. Furthermore, read through plan coverage details thoroughly to find out which plans offer coverage for special conditions such as physical therapy, pregnancy and mental health care. Another important factor to consider when buying health insurance is whether or not plans cover nursing home care. Even if you are young, a major accident or a surprise medical event could incapacitate you and force you into full-time nursing care.

Vision and Dental

Providers might offer vision and dental care under separate health insurance plans. You might have to pay additional monthly premiums, deductibles and co-payment fees to receive vision and dental care through certain providers, depending on the provider you choose. However, depending on the plan you buy, you might be able to get vision and dental coverage included in the costs of your basic plan.


About the Author

Rhonda Campbell is an entrepreneur, radio host and author. She has more than 17 years of business, human resources and project management experience and decades of book, newspaper, magazine, radio and business writing experience. Her works have appeared in leading periodicals like "Madame Noire," "Halogen TV," "The Network Journal," "Essence," "Your Church Magazine," "The Trenton Times," "Pittsburgh Quarterly" and "New Citizens Press."

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