Find out what your health insurance policy can cover, when it can start, and what you can expect to pay out of pocket.
Which specific benefits should I have on my health plan?
This depends on your situation. If you or your partner may become pregnant, for example, look for the maternity benefits on each policy. If pregnancy isn't something you're concerned about, you might want to opt out of a maternity benefit to save money on your premium. It's a balancing act, but be sure that any prospective health expenses are covered before buying your health plan.
What is a mandate benefit?
Mandate benefits are coverages required by state law. For example, most states require that health plans provide coverage for the treatment of substance abuse. Depending on your state, specific mandate benefits could include:
- Medical care for newborn children
- Coverage for the treatment of mental disorders
- Coverage for the treatment of nervous disorders
- Hospice care
There are between 20 and 60 mandated benefits in most states. To learn more about state-mandated benefits — and how the Affordable Care Act will affect them — check out this page from the National Conference of State Legislatures
What's not covered by health insurance?
Elective procedures like plastic surgery are often not covered by health insurance. When you shop for a health plan, check to see if it includes coverage for the following:
- Preventive care (like check-ups and vaccinations)
- Hearing aids
- Vision care
- Long-term care
- Prescription drugs (generic and branded)
- Out-of-network doctor visits or hospital stays
- Psychological treatment
Each policy differs, so if you're confused or unsure whether any of the above are included in a health plan, call an expert before you apply.
What are maximum out-of-pocket costs?
Most health insurance companies have caps (or ceilings) on out-of-pocket costs. This part of your health insurance plan limits your financial responsibility for all medical expenses. When you reach the financial limit through deductibles, copayments, and coinsurance, your insurance company will cover your health expenses for the remainder of your policy term.
When comparing health insurance plans, it's important to determine the max out-of-pocket cost for each before making a decision.
What is coinsurance?
Coinsurance is the percentage of health insurance expenses that you and your insurer agree to cover. In many group insurance plans, coinsurance is 80/20. That means you are responsible for 20 percent of the cost of medical expenses, even after you've paid your annual deductible.
What are my health plan payment options?
This varies by health plan, but you can typically pay your premium once per month or once per quarter. In most cases, you can pay by check or credit card, and you can set up an automated funds transfer through your bank to make sure you pay on time.
Why is COBRA more expensive than my previous health insurance plan?
If you were covered by a group plan through your former employer, you most likely weren't paying 100 percent of your premium. Since COBRA functions like a group plan without the benefit of an employer's assistance, you end up paying around 102 percent of your premium to cover administrative expenses.
How soon can my new health care begin?
When you apply for a health plan, you can request to have your policy go into effect between one and 90 days into the future. Because the application process can take some time, your plan may not start to cover you and your family as soon as you'd like. If you need health care as soon as possible and you're getting a quote through eHealthInsurance, use eSign on your application to help expedite the underwriting process.
Can I get help in resolving a claim after I buy my health plan?
Our partner eHealthInsurance provides expert customer service even after you buy your plan. Whether you prefer to email, chat online, or call an agent, our partner is available to help you resolve a billing or claims issue. No extra fees will be charged at any time for customer service.
Does my health plan cover me when I travel outside the U.S.?
Many plans do extend outside the U.S., but before you head to Mexico, Canada, or overseas, check with your insurance company to find out whether you're covered. Certain plans boast international networks, allowing you to save a lot of money by going to an in-network doctor or hospital if an injury or illness occurs.
If you're considering an out-of-country procedure (also known as medical tourism), our best advice is to research, research, research. Talk to your health care provider and read up on all of your available options. Find out how reputable and reliable a facility is, and understand the expenses involved before you commit to out-of-country health care.