Tips On Shopping For
Health Insurance

Some important terms to understand when shopping for health insurance policies:

  • Deductibles - How much of the initial costs must you absorb in the way of a deductible? Is it charged only once in the calendar year? Is there a limit of say 2 or 3 deductibles per family or must each member satisfy it?

  • Co-insurance - Beyond the deductible, what percentage of the expense must you pay, such as 10% or 20%?
    IMPORTANT: Is there a "Stop-Loss" provision which eliminates all co-insurance and pays 100% of the charges after you reach $1,000 or so in out-of-pocket expense?

  • Benefit maximums - Maximum limit should be "unlimited" or extremely high; e.g. $2,000,000, due to potential costs of major surgery, hospitalization, a series of family illnesses, etc.

  • "Inside limits" - Separate limits like "$200 for x-rays," etc., should be avoided in favor of "comprehensive coverage", i.e., a flat percentage of the cost incurred.

  • Child coverage - Determine age limits on dependent coverage. Full- time students may be covered until 22 or 23.

  • Outpatient benefits - Examine outpatient benefits carefully, since many procedures are now done on an outpatient basis due to the high cost of hospitalization.

  • Preferred providers - Some medical plans call for the use of a preferred supplier and provide a list of doctors and/or hospitals from which to choose.

  • Pre-existing conditions - In evaluating a policy, you should determine whether it limits or excludes coverage for existing health conditions. Many policies do not cover health problems that you have at the time of purchase or some you may have had in the past.


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Last modified: February 06, 2015