There’s that popular Kenyan adage declaring that most people are one medical emergency away from sliding into poverty and/or bankruptcy. For most people, talk about the importance of health insurance is preaching to the choir and there is no overstating the importance of it. The search, however, can be stressful especially with all the options to pick from and all the negative stories circulating about insurance companies that desert people in their very hours of need. Here are some things to consider as you shop for insurance that will hopefully offer useful guidance as well as reduce the stress and anxiety of the entire process.
1. Budget – Premiums & Deductibles
Step one as with other purchases is determining what your budget is. Premiums refer to the amount of money you pay every month for coverage and are the most obvious expense related to health insurance. It however is not the only expense you should factor in. The deductible refers to the amount of money you pay upfront before insurance coverage begins. Lower premiums usually mean higher deductibles and other out-of-pocket expenses such as prescription drugs so the cheapest plan may not be the best option.
2. Prescription drug coverage and out-of-pocket expenses
Different insurers have comprehensive lists of the drugs covered that you can ask for to compare and contrast with other health insurance providers. If you are currently on any drug, you need to find out if your medication is covered by the insurer. You also need to read the fine print because some insurers require patients to try low-tier drugs before getting authorization to move on to brand names that generally cost more. You may have to pay out of pocket for expensive medication which defeats the point of having health coverage.
3. Know your network and specialists
You’ve seen the signs in hospitals highlighting what insurance covers they accept. You need to find out the medical facilities that are in your insurer’s network. Are your preferred hospitals either because of location or perceived quality of service included in the network? If you already have a doctor with whom you have built rapport, you need to find out if they are covered or if your insurer has a network of preferred doctors and hospitals.
If you have no preferred doctor, you could pick one from the insurer’s list, call them, and set an appointment just to see what you could be getting into before signing on the dotted line. If you have a condition that requires you to see a specialist, make sure there is one in the network that has good reviews or that you like and trust.
4. Regular physicals and health screenings
Many health insurance plans cover preventive care such as regular physicals and health screenings. Find out what is covered by each insurer as part of their wellness plan and/or preventive care and if there are any exclusions. The extent of the coverage is what counts.
5. Ob-gyn
Make sure your reproductive health needs are covered. It’s a good idea to look over the coverage provided for pregnancy, birth, and post-natal care too. While all health insurance plans cover pregnancy and childbirth, the levels of coverage vary from plan to plan. Compare and contrast especially if you intend to have children. Parenting: 4 Things You Should Know About Your Maternity Insurance Cover
6. Additional services
Compare what additional services are offered by different plans. Other services include drug and alcohol rehabilitation, mental health care, counselling, home health care, nursing home care, hospice, experimental treatments, alternative treatments, and chiropractic care. Other wellness perks include gym memberships, rides to doctors’ appointments, video conferences with doctors at any time, and even legal consultations.
7. Exclusions
Read the fine print on the exclusions and limitations of each policy. Exclusions refer to the provisions written into insurance policies eliminating coverage for certain services. Some health insurance policies don’t cover dental and others don’t have vision coverage. Make no assumptions about what is included in your policy. It’s important to know what’s excluded so that you are not left on the hook for a service you needed.
8. If you need help, ask for it
If at any point you are overwhelmed by all the comparing and contrasting or if you don’t have time for a deep dive, you can always ask for help. Talk to an insurance broker you trust or one with great reviews. A good insurance broker has an in-depth knowledge of all the offerings and can guide you in the right direction depending on your needs.
Choose a health insurance provider that is reputable with great customer reviews. Don’t underestimate customer experiences and reviews. Read the fine print about the policy including what is covered and what is not. Take your time and you should be able to find one that fits your budget and meets your healthcare needs.
Check out this article on The importance of health insurance cover and What types of healthcare plans are best for a 20-something-year-old?
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