5 Key Questions to Ask Before You Pick a Plan

The answers will help you find the ideal coverage for you

Woman holding baby using a laptop at a cafe.

In-network versus out-of-network. Lower deductibles versus higher ones. Coverage for branded medicines versus generics. Why is choosing health insurance so complicated?

Open enrollment can be overwhelming, agrees licensed practical nurse–turned–health care financial adviser Michelle Katz, MSN, LPN. With so many factors to consider in what feels like a short deadline, it’s a lot to manage on top of your daily routines.

The trick, she says, is to answer a few key questions before you dive into the details of the plans you’re considering. 

#1. How have your needs changed since last year?

A big life change is your cue to revisit your current health plan and see where you may need more (or less) coverage, says Katz, who is the author of Healthcare Made Easy

Maybe you or one of your insurance dependents were recently diagnosed with a new condition, for example. If so, you want to make sure your plan covers your condition and all of the related treatments.

Or perhaps you’re expecting a baby or trying to conceive in the next 12 months. “Might you need a C-section? Days in the hospital? Radiology?” says Katz. “You may think a plan covers a hospital stay for the birth, but not consider all the extra stuff.”

On the flip side, if an older child is now moving onto their own insurance plan, you may not need as robust of a plan.

#2. Has your plan or coverage changed?

Sometimes employers change plans between enrollment periods. Check in with your human resources department to make sure you understand which plan you’re on‚ and what you might be signing on for next year.

#3. Are your essentials covered? 

If you have regular prescriptions and/or ongoing treatments that you know you’ll continue to need, make sure that whatever plan you’re considering includes them. 

When it comes to prescribed medicines, find out if the plan only covers (or won’t cover) generics. Also ask about the out-of-pocket costs on brand-name medicines. You may find it helpful to loop in your doctor; sometimes they can prescribe different medicines that might help your bottom line. 

#4. What have you been spending on health care?

A look at last year’s claims can spotlight your biggest costs (medication, specialists, specific therapies) as you anticipate this year’s needs. 

“That can help gauge where your priorities are,” Katz says, then you can plan accordingly.

Don’t forget about your dental and vision needs! Those costs can add up, especially if you have many family members who need exams or extra care. Crunch the numbers from last year’s claims to see if the premium costs are worth it.

#5. Do you need preventive screenings or complementary treatments? 

Depending on your age and personal or family health history, your doctor may recommend certain preventive screenings in the coming months. Katz suggests giving the office a quick call to find out if you’re due for any tests, say, for colon or breast cancer. Then cross-check with the plans you’re considering to make sure you’ll be set with coverage.

In addition to screenings, some plans cover health care memberships, acupuncture, massage, and other complementary treatments with proven preventive health benefits. For example, FDA-approved medical procedures like Botox can be indicated for chronic migraines, excessive sweating (hyperhidrosis), and arm spasms (upper limb spasticity), Katz says. 

Again, check with your doctor to see what treatments might be right for you. And then look at the plan details to see what’s covered. Pay close attention to the frequency and total number of allowable treatments.