Important Questions to Ask

What is the dollar amount of the deductible? This is the first number to know. It’s what you’ll pay before the insurer contributes anything.

Is the deductible per year or per illness? A per-year deductible is preferable. A per-illness deductible resets every time you’re treated for a new condition.

What percentage of medical expenses does the policy cover? This tells you your share of costs after the deductible is satisfied.

Does the policy have a co-insurance cap? It should. This is the number that limits your total out-of-pocket exposure for the year.

What is the maximum lifetime dollar amount? Any limit below $1 million is insufficient. Look for a policy without a lifetime cap if possible.

What are the emergency room deductible terms? ER deductibles are often higher than standard deductibles and are designed to discourage non-emergency visits. Know what triggers the higher amount.

How soon after being admitted to the ER must you notify your doctor? Many policies require prompt notification. Failing to comply may mean your expenses aren’t covered. Know the deadline, and follow it.

Does the policy limit coverage for specific charges, such as room and board? Insurers sometimes insert internal caps on certain costs that are lower than actual market rates. This can result in you paying more than the co-payment percentage suggests. Check whether private hospital rooms are covered as well.

What is the maximum number of days your hospital stay will be covered for a single illness or injury? Some policies cap covered inpatient days. If yours does, you may need a second policy to cover costs once your primary coverage stops.