It’s important to know what services a health plan covers and how much you’ll have to pay for those services. Until recently, people had a hard time finding details about their insurance plan.
The health care law requires insurers to give consumers a Summary of Benefits that’s short and easy to understand. Make sure you ask for one on any insurance plan you’re thinking about buying. The law also requires all plans to cover essential health benefits, which include services needed to help prevent and treat a serious disease such as cancer. Still, health plans cover different doctors and hospitals, and costs for those that aren’t in their network can be much higher. You’ll want to read about the benefits and ask questions about the health plans you are considering. Here we list some of the things you should look for in a health insurance plan.
These are the health care services a plan covers. Most plans cover basic benefits such as doctor’s visits, hospitalizations, preventive care, and prescriptions. But if you have special health needs, such as costly drugs or need to see certain medical specialists, you may want to be sure the plan covers these, too.
Make sure you know how much a health plan will expect you to pay for your care in the form of monthly premiums, annual deductibles, co-pays, and co-insurance before the plan will pay for the services you need. (These are often called out-of-pocket costs. See the section, “A breakdown of the costs of health insurance” for more
A health plan may require you to get care from certain doctors, specialists, hospitals, and clinics. Some plans have broad networks that offer a lot of choices for care, while others have narrow networks in which choices are more limited. Before choosing an insurance plan, gather up the names and contact information of your doctors. Have all of your prescription bottles nearby. Then you can call the plan administrator to find out the following:
- Are the doctors you’ve been seeing included in the plan’s network?
- Does the network include specialists and facilities you may need to visit for a certain health problem?
- Are your prescription drugs covered?
Where can I get help?
Information is available in several languages online through www.healthcare.gov and www.getcoveredamerica.org. You can also learn more through the Health Insurance Marketplace toll-free call center at 1-800-318-2596 or TTY 1-855-889-4325 – both of which are available 24 hours a day, 7 days a week.
Details on understanding and choosing health insurance can be found online at www.healthcare.gov/using-insurance/understanding/basics .
You can use the website https://localhelp.healthcare.gov to find people in your community who can help you apply, enroll, or give you answers to any questions you might have.
The American Cancer Society Cancer Action Network has facts and tip sheets about health insurance at www.acscan.org/healthcare/learn .
No matter who you are, we can help. Contact your American Cancer Society anytime, day or night, for information and support. Call us at 1-800-227-2345 or visit www.cancer.org .