Medical Insurance: What to ask and what to look for in a policy

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Medical Insurance: What to ask and what to look for in a policy
Medical Insurance: What to ask and what to look for in a policy

What to ask and what tolook for in a policy

George and his wife spent months hunting for individual medical insurance after he had opted for early retirement. For her, the find was easy, although the policy she chose turned out to be a long ways from satisfactory.

For him, it was a different story. He had received a stent in an artery six years earlier, and although he was on no medication, did not have a heart condition, and had received chelation therapy which had given him a clean bill of health regarding the artherosclerosis, company after company refused to insure him at any price.

He finally was accepted by a company that was endorsed through his utility co-op, but had to accept an exclusion for anything relating to coronary arteries. Other than that and the $2500 per event deductible, the policy seemed pretty good.

But when he tried to get it to pay for a treatment that removes heavy metals from his system (he accumulates cadmium, mercury and aluminum from exposures on his job) he was told that the condition was pre-existing and the company would not pay for two years.

Since that is the only condition for which he sees a doctor, the insurance company gets to profit from his health insurance premiums for two full years before they will pay a nickel for his care.

Regardless of the difficulties, hospitals expect you to come in with insurance. If you cannot pay, they do not have to take you unless your life is in danger, and then they only have to “stabilize” you before discharging you.

And, the hospital bill alone never mind the doctor’s fees and follow up care will bankrupt an upper middle class family very quickly. The policies are intricate, requiring that you ask a lot of questions before accepting one, but we can get you started with information from top companies that have been in the business for many years.

Once you begin talking to agents, you should make it clear that you are going to be comparing plans through several companies and will not commit to any high pressure sales strategies. If a company is worthy of your business, they will be willing to let you shop for the best program. In any case, there are certain types of insurance programs on the market that you probably do NOT want unless you have health issues that prevent you from getting anything else.

A key to getting cheap medical coverage that is reasonably satisfactory is in knowing what to ask the agent. All companies will have some very attractive features the agent can use to gloss over the finer details that might prove disappointing later. The following points will help you remember what to ask.

  • What is the company rating? Is it financially sound?

  • What is the company record for rate increases? Are rates typically increased if you should have a major illness?

  • Is there a pre-existence clause or a waiting period? How long?

  • What type of insurance is available—Traditional fee for service, HMO, or PPO?

  • How widespread is the network?

  • Are prescription drugs included, and at what rate?

  • Are specialists such as chiropractors or orthodontists included?

  • Is the policy guaranteed renewable to age 65 when you will be eligible for Medicare?

  • How do the deductibles and copays work? They may not be as simple as the group insurance you are used to.

Regardless of the type of health care you choose, you need a trained professional who is willing to take the time to explain not only the selling features, but also the terms of the actual policy once you receive it.

Determining a company’s financial ratings

The financial status of a company is public knowledge. You can also find out how many lawsuits have been filed against the company and whether the Better Business Bureau has any record of complaints. The following organizations can give you information on the rating and financial soundness of the company.

  • Standard and Poors (

  • Weiss Research (

  • A.M. Best (

Get started by requesting rate quotes and information from some of the well known health insurance companies in the industry.

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