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Capitol Pressroom

10 questions to ask when you enroll in New York’s Health Exchange

New York’s health exchange opens on Oct. 1, and on Friday’s Capitol Pressroom, Susan Arbetter spoke with Your Health Advocate’s Karen Laing about questions shoppers should have in mind when they pick their insurance.

Those questions are below. You can get more information and shop for insurance at www.newyorkstateofhealth.ny.gov.

1. Does this insurance company participate with my favorite doctor, specialists, dentist, pharmacy, hospital, and urgent care center? If not, you have to choose, pick another insurance plan or pick new doctors.

2. Are the medications I take on the insurance company’s formulary list? If not, they will not pay for your medications. Find a new insurance company or ask both your doctor and your pharmacist how difficult it will be to switch to new medication.

3. What kind of coverage does this plan give for urgent care centers, physical or occupational therapy, mental health care (inpatient and outpatient), drug/alcohol rehab, in-home care?

4. What is my deductible, what are my copays or co-insurances? Can you afford those on top of the premium you pay just to have the insurance?

5. Does this health insurance company cover you well in areas you regularly travel to? In your home state, in another state, in another country?

6. What exactly is covered and not covered by dental insurance? Emergency care? Orthodontics? Oral surgery? Dentures? How many providers does this insurance company work with in the area?

7. What is covered by the vision care? How often can you see the eye doctor? Get new glasses? Are contacts, bifocals, trifocals covered? Anti-glare? Breakage?

8. Does the insurance company work with national medical centers for rare illnesses? If you want a second opinion for a catastrophic illness (like going to a national cancer center after diagnosis) will they cover that?

9. Ask your doctor’s office if this insurance company is easy for them to work with. You don’t want to pick an insurance company that has a poor reputation with your provider.

10. What happens if I make a late payment to my health insurance company? What happens if I am seriously ill and cannot afford my insurance anymore? 

Bonus!

Once you have insurance, schedule appointments for your free annual exams immediately! Otherwise, you may have trouble getting an appointment when you need one. As medical offices overfill, they will begin to refuse patients who don’t come in for annual exams, or don’t follow through with medical recommendations.

 

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