Advanced Questions

Am I eligible for subsidies, tax credits, or cost-sharing reductions?
Are my current doctors and hospitals in-network?
Are my medications covered (formulary tiers)?
Are preventive services covered before the deductible?
Are there any benefit limits or coverage caps?
Are there waiting periods for pre-existing conditions?
Are wellness programs or gym discounts included?
Can I fund an HSA, and is the plan HSA-qualified?
Can I keep my doctor if I switch plans?
Does it include vision, dental, or extra benefits?
Does the plan cover the services I need (e.g., mental health, maternity)?
Does the plan include telemedicine or mail-order pharmacy options?
Does the plan require referrals or prior authorizations?
How does the insurer handle claim disputes?
Is emergency care covered when I’m away from home?
Is out-of-network care covered and at what cost?
Is the insurance company financially stable and reputable?
What are copays and coinsurance?
What are the options for short-term or limited-duration plans?
What family members are covered under the plan?
What is my monthly premium?
What type of plan is it (HMO, PPO, EPO, HDHP)?
What’s covered under emergency, hospitalization, and lab services?
What’s the annual deductible?
What’s the out-of-pocket maximum?
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