What Questions Should I Ask Before Getting Health Insurance in Maine?

Did you know that 27.5 million people did not have health insurance in the year 2018 in the United States? If you are part of this statistic but are now looking at your health insurance options, you are in the right place. We are going to go over the questions you should ask before getting health insurance in Maine.

Keep reading to learn what questions will make it easier to narrow down which insurance provider to go with.

  1. How Much Will It Cost?

One of the first questions you should ask is "how much is this going to cost me?" It is a good question to gauge whether or not you can afford that insurance option or not.

Keep in mind that the cost of your health insurance will depend on the premium that you choose, your out-of-pocket max, and your deductible. You want to know the cost of each of these upfront. 

The premium is the monthly amount that you will have to pay in order to stay covered and this amount will fluctuate depending on how high or low your deductible is. The deductible amount is how much you will have to pay before your insurance plan will start paying for your benefits. For example, if you have a $2,000 deductible, you will have to pay $2,000 before your insurance provider will pay for anything. 

The out-of-pocket max is the maximum amount that you will have to pay if you need to have an expensive procedure done. For example, if you need emergency surgery that will cost $100,000 and your out-of-pocket max is $5,000, then you will only be responsible for $5,000.

If you have already paid for your deductible for the year then that will be deducted from the total you owe for your out-of-pocket max.

  1. Is My Doctor Covered?

If you have a specific doctor that you have been seeing for years and you do not want to switch doctors, make sure to ask whether your doctor will be covered or not. Double-check if they are in the potentials health insurance company's network. 

Ask for their list of doctors and hospitals that are covered if you decide to move forward with their company. 

  1. What Benefits Are Included?

Another important question to ask is what the plan will cover. Will it cover dental and vision care as well as health? Also, will they cover prescriptions?

Take the time to ask what benefits are not covered as well to clear everything up ahead of time. Also, this tool will help you find and compare Medigap plans to ensure you choose the one that will cover your needs best. 

  1. Will Routine Exams Be Covered?

You want to ask what routine examinations will be covered such as pap tests, immunizations, mammograms, and any other routine check-ups. If there are specific exams that you know you need due to your health history, you want to make sure that you are covered and don't have to pay an arm and a leg for them.

  1. How Are Disputes Handled?

Every insurance company has its own procedures in place when it comes to handling disputes and claims that are denied. Most of them will require you to take your dispute to an arbitrator or a person that is independent to hear both sides and then make a decision about the claim.

Ask what the company's average turn around time is for resolving claim disputes. These questions will help you gauge how helpful the company is and whether or not they will be helpful during this type of unfortunate situation.

  1. What If I Have to Go to the Emergency Room?

You never know when an emergency will come up and it is always best to know ahead of time what happens then, than to have to scramble during the emergency itself. With some plans, you might have to contact your primary provider within 24 hours of the emergency visit in order for the health insurance company to cover your medical expenses.

Take the time to learn what the deductibles or copays are for an emergency visit. There are some companies that will require you to visit a specific hospital in order to be covered. This is something you definitely want to know before showing up to just any emergency room because the costs for an emergency visit are much higher than a regular doctor visit. 

  1. Are There Any Restrictions on Pre-Existing Conditions?

If you have a chronic condition or any diagnosis that you will have to deal with for the rest of your life, your policy might not cover you for a certain number of months after you begin your policy. Some health insurance companies do not cover any pre-existing conditions. 

You have to make sure you know whether or not they cover pre-existing conditions and if they do, do they have a waiting period?

  1. What If I am Traveling?

You never know if something might come up while you are away from home. Take the time to know what happens if you need to go to the doctor while you are traveling. Ask if they will pay for your services or if you have to pay and then they reimburse you. 

Ready to Choose Your Health Insurance in Maine?

Now that you have the top questions to ask when you are shopping around for health insurance in Maine, you can start making a list of the potential insurance providers. Once you have your list in order, it is time to ask every single company on your list, all of the questions above. 

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