Questions to ask when comparing health plans

What does the plan pay for and what does it exclude?

As of Jan. 1, 2014, due to health reform, most health plans must include a standard set of benefits. These are called "essential health benefits (www.healthcare.gov)" and include services, such as maternity and newborn care, preventive services, and prescription drug coverage.

Find out how the plan works

Ask:

  • 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)?
  • Are your prescriptions on the list of covered drugs (this is generally called the "formulary" list)?
  • Can you see your provider?

Ask 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?
  • Are some types of care excluded?

As of Jan. 1, 2014, most plans cannot impose pre-existing condition waiting periods on anyone.

To help you compare plans, use our health plan comparison form (PDF, 98KB).

Updated 03/27/2014

See also

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