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Important Questions to Ask When Buying Health Coverage

 Shopping for health insurance can be confusing and overwhelming, and choosing the wrong coverage can be a costly mistake.  To help you get the information you need to make an informed decision, we have developed a list of questions to consider when shopping for health insurance.

QUESTIONS TO CONSIDER WHEN SELECTING A HEALTH INSURANCE PLAN:

WHAT BENEFITS ARE MOST IMPORTANT TO ME AND MY FAMILY?

Individuals and families utilize different health care services based upon medical conditions, age, and family needs.  Review benefit information for coverage of medications or services that you use. 

WHAT ARE MY OUT-OF-POCKET COSTS FOR HEALTHCARE?

Your overall health care costs will include your premiums and any other out-of-pocket costs your plan requires.  These might include deductibles, co-payments, and co-insurance.  To compare the affordability of each plan, estimate your annual health care needs and calculate the total amount you would pay for these services under each plan you are considering.

DOES MY MEDICAL PROVIDER ACCEPT THIS INSURANCE PLAN?

If you already have a trusted medical provider in your area, make sure that they accept patients that carry the insurance coverage you are considering.  You can review provider directories for information on in-network providers.

IMPORTANT: If you receive care from an out-of-network provider, you may be responsible for the difference between the usual and customary amount (or allowable amount) that your plan pays for the service and the amount the provider charges for the service.

DOES THE COMPANY HAVE A HISTORY OF FINANCIAL PROBLEMS OR CONSUMER COMPLAINTS?

A company's past problems can indicate future problems for their insureds.  Before purchasing an insurance policy check the Texas Department of Insurance's company profile website for information regarding the company's financial rating, complaint ratio, and any enforcement actions the Department has taken against the company.

ADDITIONAL QUESTIONS TO CONSIDER WHEN SELECTING AN HMO:

WHAT IS THE HMO'S SERVICE AREA?

HMOs cover specific service areas.  Review the HMOs' membership information to find one with a service area close to where you work or live.

ARE MEMBERS SATISFIED WITH THE PLAN?

Current member satisfaction is a good indicator of the level of service an HMO provides.  Comparing Texas HMOs is an annual report of HMO consumer satisfaction.  Review the information in this report to find out how current members feel about the HMOs you are considering.

DO MEMBERS RECEIVE QUALITY CARE THROUGH THE HMO'S NETWORK?

HMOs provide health care services through a network of doctors, hospitals, and other health care providers.  The Guide to Texas HMO Quality is an annual report comparing the services received by consumers of different Texas HMOs.  The report looks at what percentage of an HMO's insureds receive certain health care services such as immunizations, cancer screenings, and prenatal care in a timely fashion.  This report can help  you compare how HMOs perform in delivering health care services to combat significant public health issues.