Important Questions to Ask your Advisor before Deciding on a Health Plan

Deciding on a Health Plan

Buying a health insurance plan is not an easy task, especially for individuals who don’t have clarity on the different terms of health insurance. Such people should make sure that they ask their insurance advisors or health insurance guide some important questions, which will help them choose a plan that well fits their budget, and efficiently cater to their requirements.

Ask about the type of health plan?

While buying a plan, first try to find out about its type, whether it is an indemnity health plan or a managed care plan. In an indemnity health plan, you are required to pay a percentage of the healthcare costs, and the insurance company pays the rest amount. In indemnity plans, you also have the flexibility to choose your doctors. However, with managed care plans like HMO or PPO, you have minimal out-of-pocket expenses. In this plan, you or your employer pays a particular amount as a monthly fee for the received healthcare services, but you are restricted to visit only those doctors, who are in contract with the HMO. In PPO plans you or your employer may receive a discount if you use in-network physicians. However, you have the option to visit a doctor outside the PPO system but will require to pay more for the services.

Is My Doctor included “In-Network”?

After deciding on the right type of plan, you have a doctor to whom you visit for any healthcare need. Irrespective of the type of plan you choose, you need to make sure that your current doctor is included in the network. Otherwise, you will need to find a doctor who is included in-network. However, you need to know that out-of-network doctors cost more if you have PPO plans, and you might not even think of out-of-network doctors with some HMO plans.

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How much the Plan will Cost?

While buying a health plan, you should always check the total cost of the plan before deciding to buy the plan. You should remember that your total health plan cost comprises of the premium, deductible, and out-of-pocket maximum. You should know that these three costs will be up-front, and these vary from plan to plan and will impact the amount you owe as the total health plan cost.


Premium is the amount that you are required to pay every month to stay covered. Suppose, if you have a monthly premium of $300, then you will be required to pay $3,600 annually.


Suppose you have a deductible of $ 2,000 in your health plan, then you are required to pay for the first $ 2,000 of healthcare before your insurance companies start paying for certain benefits. You might think that what is the need for insurance when we are paying our bills, but the benefit of the health insurance is you are paying a negotiated rate that is normally below the full price. Besides, all the money spent by you is tracked, and after meeting your deductible amount you will be required to pay much less.

Out-of-pocket maximum

Suppose you have a plan with an out-of-pocket maximum of $4,000, and due to some health problems you require a medical procedure that costs $50,000, then you will be responsible to pay just $4,000. In case, if you have previously met your $2,000 deductible, then you will just need to pay $2,000. The out-of-pocket maximum was designed to protect you from paying huge medical bills. You only need to make sure that you are receiving the treatment at an in-network hospital.

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Which metal-tier plan will be right for me?

You first need to pick your metal tier, as it determines the amount you will be required to pay per month, and also your deductible amount. There are differences between each tier of plan, and the right metal tier plan for you will depend on the amount of healthcare you are expecting to receive in the next year.

Bronze Plan

Bronze metal tier plans come with a low premium and high deductible, and this plan will suit those who rarely see a doctor, and wish to keep their monthly health plan premium low.

Silver Plan

This is the most popular metal-tier plan opted by a majority of policyholders. Silver-tier plans have a moderate premium and a moderate deductible.

Gold Plan

Gold plans have a higher premium amount and a lower deductible. These plans are favored by young individuals having family and dependents so that they have coverage for the various healthcare needs throughout the year.

Platinum Plan

These plans have the highest premium and lowest deductible, and best suit the people who frequently have health issues, and require frequent tests and prescriptions.

You will require to choose a metal tier depending upon your health and financial conditions. If you are a fitness freak and want to have coverage for a medical emergency, but wish to keep your monthly premium low, then Silver or Bronze plan will be a good option for you. However, if you have a complex medical issue, and you require tests, surgery, and prescriptions, then Gold or Platinum plans with low deductibles will be a better option for you to save money throughout the year.

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What Happens if I Go to the Emergency Room?

To be covered for your healthcare expenses by your health insurance company on visiting the emergency room, you need to contact your primary care physician within 24 hours of your visit. You should be aware of any deductibles or copays associated with the emergency room visit, as in some of the plans you are required to go to specific hospitals or service providers. These things are important for you to know and understand before buying a plan so that you don’t have to wait for an emergency to find an answer. It is better to be prepared and be aware of yours and your health carrier responsibilities. You should also remember that there are a lot of the same functions in many urgent care facilities and emergency rooms. So you should know about the urgent care options in your area, to be prepared in case of an emergency.

These are some of the important questions, as there are several other worthy things to ask your health insurance company. Therefore, it is important to have someone by side, who has good knowledge about the healthcare industry, and about all the health plan options. While shopping for a new health plan, you can seek advice and assistance from the health insurance portal to get help in finding a plan that is perfect for you.

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