Health Insurance Checklist: What you need to know

Doctor's advice / Sanitas Medical Center

Date: November 3, 2021
Health Insurance Checklist: What you need to know

There’s more to buying health insurance than just signing up. How do you know if you have the right kind of coverage? Or the right amount? Start by deciding what your healthcare needs really are. Then you can look at which plans cover your needs best.

First, it helps to understand some basic terms. A health plan is a contract or agreement that spells out the relationship between you, your providers (those who provide healthcare services) and the issuer (the insurance company that issues the plan). A plan’s Summary of Benefits tells you:

  • Covered services: What medical services are eligible for coverage and which ones aren’t.
  • Provider network: Which doctors, hospitals, labs and other providers you should see to get the best pricing.
  • Monthly premium: How much you pay to be covered by the plan.
  • Cost-sharing: How much you pay to use health services. This may include deductible, copayments and coinsurance.

Choose a plan that meets your healthcare needs

Health plans come in many shapes and sizes. To see if a plan meets your needs, start by figuring out what your needs are. Then you can compare costs to find coverage that fits your budget.

  • Which providers? If you have preferred doctors and hospitals, check to see if they’re in the provider network for any plan you’re considering. By using in-network providers, you always pay the lowest cost for care. Note that different plans from the same insurance company may have different provider networks.
  • Who’s covered? Decide if you want coverage to include immediate family members.
  • What care do you need? The amount and type of care you need affects the cost of the plan. If you’re young and healthy, you may not need to see your doctor as often as someone who is older or living with a condition like diabetes or heart disease.
  • Do you take medications? If so, you may want a plan that covers prescription drugs. If not, you may want to skip plans that include prescriptions—at least, for now. If your prescription needs change in the future, you can switch to a plan that includes prescriptions later.
  • Planning a family? If so, choose a plan that includes pregnancy and delivery care. Otherwise, you can choose a plan that doesn’t cover those services. Either way, most plans cover pediatric care for children.

Understand your costs

Patients with health coverage usually pay two kinds of costs: The monthly premium is the cost to have the plan available for a year. Premiums are paid to the insurance company. Cost-sharing is the cost of using the plan when you see a provider. There are three kinds of cost-sharing, usually paid directly to the provider:

  1. Deductible: How much you must spend on healthcare at the beginning of the plan year before your plan starts to pay its share of the cost of your care. The deductible re-sets to $0 every year.
  2. Copayment: A flat fee that covers your share of the cost of a medical service. The plan typically pays the rest. The copayment may vary depending on the service.
  3. Coinsurance: A percentage of the cost you pay for a doctor visit, hospital stay or other healthcare service. Many plans have 20% coinsurance for certain services, meaning the insurance company pays the rest.

First steps

Gather the information you’ll need before you start looking at health plans. Whether you explore on your own or through an insurance agent, it’s a good idea to have this information available for easy reference:

  • Social Security numbers of all family members you want to include for coverage
  • Income information, such as pay stubs, W-2s or tax returns
  • Policy numbers of all healthcare plans you have now
  • List of all doctors, hospitals and other healthcare providers you use, including contact information
  • List of all prescription medications you use

Important takeaways

  • Agent: An insurance agent can help you sort through your options, explain the details, and choose a plan that works for you. They’ll also advise you if you’re facing an important decision about care and help you get the most benefit from your plan. Sanitas can put you in touch with an agent if you wish. Or contact the Blue Cross Blue Shield affiliate in your state.
  • Pricing: Understand the relationships between premiums and cost-sharing. Plans with low premiums are not always the cheapest, because they may have high cost-sharing (deductibles, copayments and coinsurance). So look at all the costs before deciding which plan(s) give you the best value for your money.
  • Network: Understand why it’s important to use in-network providers whenever possible. If you use an out-of-network provider, most plans cover less of the cost—or none at all. This leaves you to pay more than you would by using in-network providers.

At Sanitas Medical Center, we work closely with your Blue Cross Blue Shield plan to offer a simplified healthcare experience, so it’s easy to get the quality care you need at affordable prices. For help deciding on a plan that fits your needs, contact your Blue Cross Blue Shield plan, insurance agent or Sanitas Medical Center at 1-844-665-4827.