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Ok it’s been a couple of days since enrollment opened for the affordable Care Act Exchanges.  Here is a few questions you want to ask before signing up with a plan. Please make sure you know what you are buying, it may take a little research but please educate yourself.

1.       What will your prescription drug coverage be? Each plan covers you differently. One plan might cover you up to a percentage of the drug. Another might charge you a fixed rate depending on which drug it is and weather it is in its generic or brand name.  Ask the company to speak to the plan’s pharmacist and make sure you tell them the drug you take, the strengths and how many times a day you take the drug. The Pharmacist should be able to tell you if the drug is on the formulary list or it isn’t.  

2.       Are your doctors and specialists accepting the insurance policy that you want to purchase?  It’s not good enough  to know that your Dr. accepts blue cross and blue shield,  you must make sure he/she accepts the specific plan like Blue Preferred Platinum plan. Ask your Dr which plans they will accept.

3.       Does the insurance company have enough specialists on their Doctors List? First ask the insurance provider if the list on line is up to date, some do not update their lists frequently enough. Keep in mind Dr’s will come and go off these lists. Also keep in mind that even though a Dr. is on the list that Dr. may not be taking on any new patients. If you don’t do your homework on this step you could be waiting for months before you get an appointment with a specialist.

4.       What is the cost of inpatient hospital coverage? You may find you have to pay $200 a day. Or you may find that the insurance company negotiated a really good deal on hospital stays and they require you to pay 10% of that bill. Make sure you know what you are responsible for because this one could be an expensive bill for your family if you don’t pick the right plan.

5.       What is the ER visit going to cost you? Make sure you know if you have to pay a deductible or copay to go to the ER. Also make sure you know procedures you have to follow so you don’t get stuck with the bill. Under certain circumstances you may have to call a primary care physician first or before you leave an ER make sure you follow proper check out procedures. One false move and you might be paying the ER visit yourself.

6.       What Extra coverage will your policy provide?

Will it provide you with hospice care, outpatient therapy or rehab, home nursing care, dental coverage, vision coverage, Chiropractic care, psychiatric benefits? Will it cover your for emergencies while your outside the country on vacation? Does it offer any benefits like paying some of your gym membership, exercise nutrition counseling,  weight loss etc. ?

Now you may be coming up with some of your own questions so write them down. The key to research is asking lots of questions. Keep in mind most likely things will continue to change as this new law moves forward and I can assure you the plans will too. It will be very important going forward that you commit to reviewing your insurance annually to see how your plan has changed and to make sure there isn’t a better one that fits your needs. Good luck and happy insurance hunting!  

 
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Steven Evans 

Your Agent and Friend

Evans Insurance Services Inc. 
my website 
Ph-610-889-9300
Fax-1-888-418-5988

                

 

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