10.5 Things You Must Know When Shopping For Health Insurance

10 1/2 Things You Must Know! (When shopping for Health Insurance)

Shopping for affordable health insurance can be a daunting task. It's especially hard if you've never had an individual health insurance policy before. Some companies and agents take advantage of the general lack of knowledge most people have regarding health insurance. This section will explain how you should properly shop for health insurance. A lot of consumers don't realize it, but health insurance exists to protect you financially in case of a major event. Make sure you purchase a comprehensive policy. Your past health history is never an indication of future events. Anyone can get involved in a car accident or be stricken with a disease like cancer. It also makes sense that as we get older more health problems are expected. If its one thing we cannot stress enough it's to make sure you get a policy that will protect you financially against a catastrophic event.

1) What is the Out of Pocket Maximum!

It's absolutely imperative that you find out what the “out of pocket maximum” is. Simply put, this is the plans stop-loss. Always ask your agent what the plans out of pocket maximum is. If the health insurance plan you are looking at does not have an out of pocket maximum you may want to protect yourself and continue shopping.

2) Know the plan deductibles!

Deductibles can be confusing since they can apply to more than one part of the health insurance plan. For example, prescription drugs can have one deductible and hospitalization can have a separate deductible. You need to find out from your agent what the deductibles are for all parts of the plan. You also want to find out if the deductible is per year or once per occurrence.

3) Ask about the co-insurance!

Co-insurance is the percentage of the bill you are responsible for after you satisfy your deductible. For example, a plan with 80/20 co-insurance means you would be responsible for 20% of the bill up to the out-of-pocket maximum.

4) Know the plans limitations!

Some health insurance plans limit doctor's visits or prescription drug coverage. Ask your agent if the plan has any limitations regarding doctor visits, prescription drug coverage or wellness visits. You will also want to know the policies lifetime maximum payout. You should have at least 2 million in lifetime coverage. Also, I highly advise that you select a health insurance plan that has unlimited/no cap on prescription drug coverage. Stay away from discount only drug coverage!

5) Get it in writing!

When an agent tells you about the health insurance plan's details, make sure it's backed up in writing. If it's not in writing then it doesn't exist. This especially applies to the, “this sounds too good to be true” situations.

6) Don't get pressured!

Purchasing a health insurance policy is a major decision. If you rush into the wrong policy you may not be able to change companies. Meaning you could have a change in health which could make you ineligible for other health insurance, therefore trapping you with the policy you have. Before buying a policy ask yourself a simple question, "In a major catastrophic event is this a policy I would want to keep?"

7) You should not meet with an agent that refuses to give price or plan information over the phone!

Some agents will refuse to give you free health insurance quote or discuss the policy over the phone. Instead they will pressure you for a personal meeting, and may also expect you to write a check during that meeting. Don't fall for high-pressure sales tactics! If an agent cannot provide you with detailed quotes and information before the meeting then continue to shop. (Or use our agency to shop for you...click here) This is not to say that meeting with an agent is a bad idea. In fact, meeting with an agent is recommended. Simply know the rates and health insurance policy details in advance so your time is not wasted.

8) Ask if it's a discount plan!

Beware of agents selling discount health plans. There are cases where the agent may not directly state that it is not insurance. Simply ask the agent “Is this a discount plan or a Major Medical plan?” If you ever hear the words "discount", "indemnity" or "basic hospital or surgery" from an agent be careful! These are signs that it is not a major medical plan, and may have major gaps in the coverage. Also be sure to never ever purchase a plan where they tell you that you have to pay for your first month before they send you any information. What are they hiding? If an agent opens a slick looking glossy brochure and wants to charge you a $100 a month to cover your entire family, quickly show the agent the door. Tell them, "I have better sense than that and I don't work with captive agents who won't show me any other plans." He or she will either be impressed or angry, but oh well, this is for YOU and not the high pressure agent!

9) Make sure there are no daily limits in the health insurance plan!

If the health insurance plan offers daily limits on hospital stays or room/board, (a "Scheduled Benefit Plan") and the plan puts caps on various hospital or surgical services like surgeon's fees, miscellaneous expenses, etc., look elsewhere! We don't and won't offer you any plan that is set up like this! If you get on a health insurance plan like this it will leave you very vulnerable. (ex. If you get on a plan that has a 20,000 cap for miscellaneous charges in the hospital, and the total for these charges total 35,000, you're stuck with 15,000 on top of your deductible and co-insurance!) Stay away from this!

10) Pre-Existing Conditions

Many of you have pre-existing conditions. The health insurance carrier will typically put a rider on these conditions and tell you that only the specific ridered condition(s) will not be covered. This is only the partial truth. Let's say you have high blood pressure and the carrier or agent says to you that only your prescriptions and doctor visits will be excluded. You ask "if I have a heart attack or stroke will it be covered"? They assure you it will. Now here is where the trouble starts, and this is for any pre-existing condition. If you have a heart attack, stroke, renal failure, etc., (high blood pressure is a real killer) and the clinical notes or findings indicate that it was as a direct result of the high blood pressure, it might not be covered. If you can select a company that rates up your condition (charges you a little extra per month) and does not impose riders, it is worth a few extra dollars. Not always possible however. We will go to bat for you when it comes to this as well. If a health insurance company offers an unfair deal we will let the insurance company know that this is unacceptable and will be looking elsewhere for coverage.

10 1/2) Run through some scenarios!

A great way to get your questions answered if you're unfamiliar with health insurance terminology is to ask the agent for examples of what you would owe or be responsible for in different situations:

A. If I broke my leg and went to the ER what would I owe?

B. If I had a heart attack and the bill was $50,000 what would I owe?

C. If I got sick, saw my doctor and got a prescription what would I owe?

D. If I need physical therapy what would I owe?

E. If I were to get cancer, and the bill totaled $200,000 what would I owe?

(Warning: Failure of any agent to directly answer these questions is a warning sign.)

If all this is a little overwhelming call us, we will be more than happy to tell you which plans we like and feel strongly about, and which ones are garbage. We can tell you how to recognize the differences pretty easily. So our final buying tip, call us or log on to our website www.ColoradoHealthSolutions.com or call 720.920.9697 so we can discuss your options confidentially.


If you’re like most, health insurance is not only confusing, but it’s like a foreign language to you and hard to understand. We are experts on individual, family and small business health insurance since that's our primary focus. When you choose us as your agency, we will work as your insurance solutions team, a team who will be there before you apply, during underwriting and after the policy is issued, regardless of what state you live in. We look forward to working with you now and in the f...

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