A Guide On Health Insurance Coverage

12 January 2022
 Categories: Insurance, Blog


With the increasing medical costs, health insurance can determine if you can access quality healthcare. Choosing a health insurance plan is not a straightforward process. You need to evaluate the components of specific health plans to ensure you get adequate coverage. This post highlights the critical consideration factors when selecting health insurance coverage. 

Consider the Provider Network 

Insurers provide health insurance coverage through an in-network of providers. An in-network provider is a contracted healthcare provider that offers medical care to policyholders enrolled in a plan. Thus, if you are fond of a particular doctor, medical facility, or pharmacy, find out if they in the list of in-network providers. In addition, you have the option of selecting a new healthcare provider from the list of in-network providers. Keep in mind that you have to pay more out-of-pocket costs to see a provider outside the in-network. The key is having an in-network provider you can trust and within your locality. 

Check-out the Prescription Drug Coverage

A considerable percentage of healthcare costs goes towards medication. Each health insurance coverage has a categorized list of prescription drugs placed under the plan. Thus, if you use prescription medication, find out if the plan covers the drugs. You can request the insurance company to provide a formulary, which is a list of covered prescriptions. Notably, the insurance companies place the prescription drugs into a tier. Thus, they may expect you to try lower-tier drugs before moving to a brand-name medication. As such, read through the health insurance fine print to know whether you have to get some medicines from out-of-pocket costs. 

Assess the Cost of the Coverage  

A policyholder must pay premiums as the cost of coverage. There is a risk of losing your coverage should you stop making the monthly payments. Also, keep in mind the other expenses associated with your insurance, such as deductibles, coinsurance, and co-pay. The deductible amount is what you pay out of pocket before the insurance company pays the rest. Notably, the lower the deductible amount, the higher the monthly premiums. Coinsurance is the percentage of costs you pay after you meet your deductible amount, while co-pay is the flat fees for medicines and services. When picking a health insurance plan, assess your ability to make the necessary payments.

Health insurance coverage is not a one-size-fits-all policy. Contact an insurance company to access your coverage needs and help you select the ideal plan based on your budget. 

For more information on health insurance coverage, contact a company near you.