Cockerill, Craig & Moore, LLC Attorneys at Law

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On Behalf of | Mar 10, 2013 | Firm News |


If you are self-employed or do not have health insurance coverage through your employer, you may be uncertain exactly what you need to consider when shopping for health insurance. Here are the key factors to look at when buying health insurance coverage.

What Is Your Total Out-of-Pocket Cost?

Because insurance policies have co-pays and deductibles, you can’t just look at the cost of insurance and purchase the policy with the lowest premium. In some instances, the deductible is for every doctor visit, not on an annual basis. In addition, if you have to pay for lab work, x-rays, emergency care or other services, a policy can become pretty expensive.

What, If Any, Limits Are Placed on Which Doctors You Can See

Most health insurance policies require that you be treated by a physician in the company’s network. If you have a regular doctor, or a specialist that you prefer to see, verify that they are in the company’s plan.   Make sure you understand the difference between a PPO – Preferred Provider Organization which permits access to a broader spectrum of physicians and care providers and often provides limited out-of-network benefits than an EPO – Exclusive Provider Organization – which requires that treatment be provided exclusively by providers in the network and may offer no out of network benefits.

Can You Choose the Hospital or Care Facility?

As a general rule, insurers offer plans that provide coverage if you go to specific hospitals or doctors. You want to determine whether the plans you are considering will pay for emergency trips to hospitals near you. You also want to know what your options are if you need medical care while traveling.

What Type of Coverage Do You Have for Catastrophic Injury?

Make certain that the coverage for major medical events is not capped too low. For example, a limit of $100,000 on a major medical event will likely not cover all costs of any serious or traumatic event, or any type of major surgery. If your limit is too low, you will be responsible for any amount not covered.

Does the Policy Cover Prescriptions?

This is an area you need to review carefully. Some health insurance policies provide different levels of coverage based on the type of drug prescribed. Some require that you get generics. Most companies have a list of those pharmaceutical products considered “experimental” and those that are approved for reimbursement or coverage.

Does the Policy Offer Additional Benefits?

You may be able to find an affordable policy that covers massage, chiropractic, weight loss, mental health and other non-traditional medical treatments. You should also check whether the prospective policy covers vision, dental or hearing issues.

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