1. The primary purpose of health insurance is to cover the BIG expenses.
Look for comprehensive coverage from reputable companies. Avoid gimmicks that purport to offer you lower "group rates" through associations that anyone can join. Remember, cheaper insurance is cheaper for a reason.
To lower your premium, consider the highest deductible with which you are financially comfortable.
Take a moment to do the math. Add up your total annual savings with a higher deductible and compare this amount to the extra out-of-pocket risk. Then consider your health history and decide if the savings are worth the extra risk. If you live a healthy lifestyle and you have a good health history, in most cases the extra savings will be worth the risk.
2. Avoid Surprises. Look for the term "Major Medical" (or similar) & avoid "Basic Medical."
In general, a Major Medical or "Comprehensive Major Medical" health plan covers medically necessary treatment unless specifically excluded. On the other hand, a "Basic Medical" or "Hospital/Surgical" typically covers only treatment that is specifically included on a schedule of benefits.
Look carefully at the difference. "Basic Medical" or "Hospital/Surgical" plans serve a purpose and their premiums are usually lower. However, if you qualify and you want the most comprehensive protection, look for the words "Major Medical" or "Comprehensive Major Medical" (or similar wording) on the offering brochure or policy.
3. Check how a health plan will pay your medical claims. Look for the term "Reasonable."
Sometimes, insurance companies will pay for medical procedures based on a schedule of fees that are considered to be the "Usual and Customary" for the region. However, if an unexpected complication occurs and "reasonable" extra medical services are required, then these reasonable extra services may not be covered under the definition of "Usual and Customary" alone.
Complications can be costly, sometimes very costly! Look for the term "usual, reasonable, and customary" or "reasonable and customary" for greater protection.
4. When comparing health plans, check the "Exclusions" carefully.
One of the first things an experienced agent looks at in a health insurance plan is the list of plan exclusions, or what is NOT covered. Often found in small print, what is NOT covered is equally as important as what IS.
Many exclusions are typical (i.e. acts of war, self-inflicted injuries, custodial care, etc.), while others are not and should be carefully considered when comparing health plans. For example, does the plan have a waiting period for certain conditions? One exclusion of a "Basic Medical" or "Hospital Surgical" plan is "anything not specifically listed in the policy.
5. If you have a favorite doctor, does he or she participate in a PPO network?
Lower-cost health plans control costs by contracting with a "Preferred Provider Organization" or "PPO." If you have a favorite doctor who is important to you, call your doctor's office and ask in which PPOs your doctor participates. Save yourself time by only comparing those plans that offer your doctor's PPO network.
6. Consider an HMO.
Health Maintenance Organizations (HMOs) usually cost less and are far better regulated than they were 15 or 20 years ago. Today, HMOs are easier to use with online access (for example, to change your "Primary Care Physician"). Also, HMOs typically have fewer restrictions on "pre-existing conditions." If you do opt to save money with an HMO, be sure you understand the terms of use.
7. Activate your memory when completing the health questionnaire. Here’s why:
The final step in obtaining health insurance is qualifying through the health questionnaire. It’s important to remember that by nature, the human mind tends to forget or minimize past or present illness. A positive attitude can be a benefit in the healing process. However, failing to disclose a material health condition, past or present, could jeopardize your coverage entirely.
Medical audits are often done when there is a major claim. By contract, the insurance company can revoke coverage and return all premiums if it can be shown that the policyholder failed to disclose a material condition on the application.
Never give the insurance company a potential way out of paying a major claim. Even though this is the last step in the process, don’t be hurried.
Disclosing past illness or injury is not an automatic negative. When truthful, always include clearly written phrases such as "complete recovery," "no further treatment," and "well controlled." It helps to clearly state the positive in writing.
8. Key concept - understand the trade-offs.
Comparing price is easy. The key is being aware of the differences in coverage which account for any differences in price. There is nothing wrong with trading some benefits for a lower premium. The key is for you to be fully aware of the trade-offs. Below are some examples.
| Lower Premium Cost | Higher Premium Cost |
| Higher deductibles and/or higher co-pays | Lower deductibles and/or lower co-pays |
| Basic Medical Plan or Hospital/Surgical Plan with broad medical exclusions. | Comprehensive Major Medical Plan with fewer exclusions. |
| Limited maximum coverage for specific items such as intensive care, mental health care, air ambulance, etc.. | More overall coverage, with fewer limits or caps on specific items such as intensive care and other medically services. |
| Reimburses only medical expenses which are "Usual and Customary". | Reimburses medical expenses which are Usual, Reasonable and Customary. |
| Co-insurance: After the deductible, you pay 20% of the next $15,000. | Co-insurance: After the deductible, you pay 20% of the next $5000. |
9. Normally, it costs no more to use a good, local health insurance agent (see Internet Secrets).
Health insurance can be confusing. A good local health insurance agent may be be able to help you at no additional cost. (See Local Agents for tips on how to find a "good" health insurance agent.)
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