9 questions to ask when choosing a health plan

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9 questions to ask when choosing a health plan

You may have a choice of plans when choosing health insurance. Here are some questions to ask when you’re deciding what’s right for you (and possibly your family).

10/06/2020

Picking a health insurance plan isn’t always easy. Knowing what questions to ask can help.

1. Is my doctor in the network?

If you have doctors or specialists you like, check if they’re in the plan’s network. Why? Because your costs are usually lower when you use an in-network doctor. Visit Find a doctor to see if a doctor is in the ConnectiCare network.

2. Is my medicine covered, and how much will it cost?

Health plans have drug lists (sometimes called “formularies”) of the prescription medicines that they cover. You can find ConnectiCare plan formularies on our website. Make sure you note if you take a drug that has restrictions, such as needing a preauthorization. That’s a requirement that the health plan approves a medicine before it’s covered.

Your benefit summary will show how much you will pay for drugs in different “tiers” in the drug list. Many plans (like ConnectiCare) also have a way for you to price a specific drug and can help you sign up for home delivery.

3. What type of health coverage is right for me?

Think about what health care services you and each family member might need in the coming year. For example:

  • Do you see a doctor regularly for a health condition?
  • Do you like the idea of using your smartphone to make an appointment for, and have a virtual visit with, a doctor?  
  • Do you take expensive or brand-name medicines on a regular basis?
  • Are you are expecting a baby, planning to have a baby, or parenting small children?
  • Do you have a planned surgery coming up?

Then, look over your plan options. Check those to see what office visits, virtual visits, medicines, and more may cost.   

4. What happens if I need care when I’m away from home?

  • Check to see if the plan covers emergency services outside of its normal service area.
  • See if it offers telemedicine services (most ConnectiCare plans include it). These let you use your phone, mobile device or a computer to consult a doctor from almost anywhere you are.
  • Find out where you can look up urgent care centers if you’re away from home and suddenly get sick.

5. What is the most I’d have to spend?

There are two things to look at with many plans:

What’s the deductible? – That’s the amount you have to pay before the plan begins to pay for covered medical expenses.

What’s the “maximum out-of-pocket” (“MOOP” for short)? – That’s the most you’d have to pay toward your covered medical expenses

6. Do I qualify for financial help?

Financial help is based on family income. It can help lower the cost of your monthly premiums and possibly lower your out-of-pocket costs for doctors’ visits and other services. You can compare plans on our website and estimate if you qualify for financial help. If you do, you apply through Access Health CT, the state’s health insurance marketplace.

7. What will I pay for services I use often?

The amount you pay for things like a visit to your primary care provider (PCP) or a specialist depends on your specific ConnectiCare plan. Your benefit summary (available by signing in to connecticare.com) shows what services require a copayment and if it is applied before or after meeting the plan’s deductible.

8. Does the plan include dental coverage, or can I buy it?

Some medical plans, by law, include pediatric (children’s) dental coverage. Some may include or offer, at an added charge, dental coverage for preventive services (such as cleanings) and comprehensive services (such as fillings and crowns). Ask if you want to know more. It’s important to take care of your teeth and mouth (it can even save your life).

9. Am I eligible for a health savings account (HSA)?

Check if a plan allows you to save pre-tax money in an HSA. Only some plans do. An HSA helps you save money to cover qualified medical expenses. There are reasons to open an HSA if you can. But you’ll also want to review the rules.

Have more questions?

We can help if you are buying insurance on your own.  We have ConnectiCare centers around the state. You can schedule an appointment, and we’ll be waiting for you!

Your human resources or benefits contact can help answer questions if you get insurance through an employer.