Once you have received your eligibility determination and know what type of insurance you are eligible for, here are some questions to consider to ensure you choose a plan that is best for you.
Provider Network
Do you want to continue seeing a particular doctor or other health care provider?
Which doctors, hospitals, clinics, and other health care providers do your family, or you currently use?
What specialists do you see?
Do you want to select only from plans whose network includes these providers?
What happens if you want to see a specific health care provider who is out-of-network? How are these services accessed under the plan you are considering?
Prescription Drug Formulary
Does the plan cover the medication(s) you are currently taking?
Are your medications brand name or generic? It is important to note that different tiers of prescription medications may have different copays assigned.
How much will my prescription cost?
Is there a separate deductible for prescriptions?
Quality Rating
Is there a certain quality rating (number of stars) that you want your plan to have?
Referrals
Does the plan require that you get a referral from a primary care physician (PCP) to see a specialist or get other services?
Cost
How much is the monthly premium?
Anticipated Need for Benefits
Do you have an anticipated need for benefits, such as a pre-existing condition or upcoming surgery?
If anyone in your household has an anticipated need for benefits, you should find out if the benefits are limited and research the extent to which these medical, pharmaceutical, and other benefits are covered.
What plan features, if any, are you interested in beyond the essential health benefits?
For example, what happens if you need access to dental, hearing, and vision services? Some plans offer specific benefits you might be interested in, such as: adult dental, adult vision, acupuncture, gym membership reimbursement, and weight loss services.
