Questions to Ask Before You Enroll
- What is the annual out-of-pocket maximum, and does it reset each calendar year?
- Are my current doctors and hospitals in-network — and will they stay in-network?
- Which services require prior authorization?
- What are the copays for specialist visits, ER visits, and durable medical equipment?
- Does the plan cover care if I travel outside the service area?
Common Surprise Costs
- Tiered drug costs that change mid-year
- Specialist copays higher than expected
- Out-of-network emergency care billed differently than anticipated
Key Takeaways
- Low or $0 premiums don't eliminate cost-sharing through copays and coinsurance.
- Always confirm provider network status before enrolling, not after.
- Prior authorization requirements can delay or limit certain services.
Specific costs vary by plan and carrier. Review the plan's Summary of Benefits before enrolling.
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