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What Questions To Ask Health Insurance Agents Before Getting A Plan?

HealthPlans of NC

Finding the right health insurance plan is no easy task. With so many options available, many people feel overwhelmed and settle for a health plan that doesn’t fully meet their needs. Working with a licensed insurance agent can make the process less stressful and give you better results. You may be wondering what questions to ask a health insurance agent.  

Before selecting a health insurance policy, talk to your agent about what questions to ask health insurance companies. Take the time to learn from your agent and get educated on all the health insurance plans available. Insurance agents are a valuable resource because they work directly for the health insurance company.

This article is meant to offer questions to ask when getting health insurance. We’ll cover topics such as insurance types, costs, and claims. Asking the right questions can give you a fuller picture of all your options so you can make the best decision possible.

Questions To Ask Health Insurance Agents About Insurance Types

There are 881,500 licensed agencies and brokers working in the US. These insurance professionals are trained to understand the intricacies and differences between health insurance plans. On your own, finding affordable care that meets your expectations may be a lengthy and time-consuming process. When meeting with your agent, use the following questions to educate yourself. 

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What Insurance Plan is Best For My Needs and Budget?

Before digging deep, make sure you understand the basics. Ask what types of health insurance plans the agent offers. The three types of health insurance plans are fixed benefit, medical, and critical illness. Questions to ask insurance companies should start with clarifying the details of each individual health plan.

What Is Covered By The Policy?

The details of a health insurance policy may be difficult to understand. The vernacular can confuse people who don’t have a background in health insurance. When it comes to understanding particular policies, here are some questions to ask when getting health insurance.

  • Are pre and post-hospitalization charges covered?

  • Are ambulance services covered?

  • Is laboratory testing covered?

  • Are all prescription drugs covered in the plan?

  • Are organ donor charges covered?

Agents should help you understand what their insurance company is offering with each plan. A good agent can answer these questions thoroughly in a way that you can comprehend. 

Does Your Health Insurance Policy Cover Routine Tests?

Not all insurance plans are the same. If you have a health disorder that requires routine check-ups, having a health insurance policy that covers them is extremely important. Otherwise, you may be paying large out-of-pocket expenses.


Questions To Ask Health Insurance Agents About Insurance Costs

In 2018, private health insurance companies covered 67.3% of the population, while public options accounted for 34.4%. This means that more than two-thirds of Americans are paying for health insurance. 

When it comes to questions to ask health insurance companies, the cost of coverage is usually at the top of the list for most people. Before picking a plan, be sure to have a clear understanding of what you are financially available for, what financial aid may be available, and what each plan costs. A healthcare insurance agent is someone who can answer questions or clarify any confusion you may have.

What Is The Cost of the Plan?

The cost of a plan isn’t always so clear. On insurance cards, you see different prices for different services. Oftentimes, this is confusing. The monthly premium is the amount you pay per month to your insurance company. There is a wide range of costs depending on the plan. Be sure to fully understand all the particulars before settling on a policy.

How is the Cost of the Insurance Determined?

Questions health insurance companies ask to include your age location and possibly health history if it is not an ACA plan. Age often plays a big role in how high your monthly premium is. A health insurance company charges more for older clients because they are more susceptible to health issues. Previous health history may also play a factor in cost. Coverage is more affordable for those that are young and healthy.

How Much Will It Cost You to Access Medical Care?

Two other terms that health insurance agents should educate you on are deductibles and coinsurance. These terms represent the amount of money you have to pay out-of-pocket for your medical care.

All plans are different, so make sure to understand each plan's deductible and coinsurance. Also, get familiar with the cost percentage the policy will cover after the out-of-pocket costs are paid.

Questions To Ask Health Insurance Agents About Insurance Claims

An insurance claim is a request of your health insurance company to pay for what it offers in your plan. Questions to ask when getting health insurance should include, “What does my policy cover, and how do I file a claim?”

2021 totals show 911,400 life and health insurance agents and 628,600 property/casualty insurance agents. Utilizing a health insurance agent can make the process of filing a claim simple and quick. Here are some questions to ask health insurance companies:

Will You Be Able to Receive Care From Your Preferred Physician?

Everyone knows that finding a great physician isn’t always easy. After finding one, you want to make sure you have an insurance plan that allows you to use them. Unfortunately, not all plans give you this option. Be sure to fully understand what physicians and hospitals are in-network. If you are not thorough in your research, you may be responsible for very large medical bills.

What is the Process for Filing a Claim?

Even though insurance agents can assist you with filing a claim, it’s important to know how the process works. Knowing what documents to fill out is vital because when an accident occurs, you want to be ready to receive your money. You should also be schooled on what questions insurance companies ask. This way, you know how to answer properly to ensure you get the money you are owed.

What is the Maximum Number of Claims You Can Make in a Year?

Sometimes health concerns come in bunches. Knowing that your plan will cover you through it all is very important. Usually, there is no limit to the number of claims within a year. However, it is possible to exceed the sum assured within your plan. Ask your agent to explain if there are any claim limits.

If you are someone that needs to make several claims in a year, be sure to choose a plan that allows this. Have your agent help you understand the fine print of each policy. This is one of the many benefits of using an insurance agent.

Things To Consider Before Getting A Health Insurance Plan

People seem to believe that proper health coverage is more important than ever. The COVID-19 pandemic has been a stark reminder of how fragile our health can be. Statistics seem to back up that claim.  

In 2021, 7.9 percent of full-time, year-round workers had public health insurance, up 1.8 percentage points from 2020. Among less than full-time, year-round workers, the percentage with public coverage increased by 1.6 percentage points to 22.6 percent during this period.

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Having coverage is valuable, but having great coverage can save you a lot of stress and money in the long run. Before choosing a plan, have concise questions ready. This can be a huge help. Be sure to understand questions that health insurance companies ask as well so you can be prepared.

  • What are the plan’s out-of-pocket maximums?

  • What about copayments, deductibles, premiums, out-of-pocket limits, and coinsurance?

  • How does the claims process work?

  • How limiting are the bargain-priced premium policies? Are they worth it?

  • Are medications covered?

  • Am I able to use the physician I want? Who is available in the plan's network?

For individuals that can’t afford healthcare, you may qualify for alternative options.

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Frequently Asked Questions

What are three general questions to ask before deciding on a healthcare plan?

Three questions you should ask should include:

  1. What are the costs of copayments, deductibles, premiums, and coinsurance?

  2. How does the claims process work?

  3. Am I able to keep my primary physician?

Should you buy health insurance from an agent?

Using a health insurance agent can save you time, stress, and money. They are knowledgeable about specific plans because they work directly for health insurance companies and are licensed as a health insurance advisor.  You can utilize an agent at no additional cost to you.

How often should an insurance agent keep in contact with current clients?

A quality health insurance agent will stay in touch several times per year. Checking in with a client can build trust and build long-lasting relationships.

Find a Local Health Insurance Agent Near You!

A good health insurance agent is familiar with all health plans within your area. They can give you grounded, knowledgeable advice that leads you to affordable, comprehensive insurance. To learn more about why you should choose a health insurance agent to assist with all your insurance needs, explore this article.

Knowing the right questions to ask a health insurance agent can be a big help in acquiring the right coverage. Before purchasing a plan, you should maintain awareness of costs and how to file a claim. Be sure also to ask your agent if medications are covered, whether you can choose your physician, and what the out-of-pocket maximum is. Using an insurance agent can save time, money, and added stress. Choose from one of our licensed agents today.

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