Do everything in your power to avoid plans with the following features:
Limited benefits
Never buy a product that is labeled “limited benefit” or “not major medical” insurance. In most states those phrases might be your only clue to an inadequate policy.
Low overall coverage limits
Health care is more costly than you might imagine if you’ve never experienced a serious illness. The cost of cancer or a heart attack can easily hit six figures. Policies with coverage limits of $25,000 or even $100,000 are not adequate.
“Affordable” premiums
There’s no free lunch when it comes to insurance. To lower premiums, insurers trim benefits and do what they can to avoid insuring less healthy people. So if your insurance was a bargain, chances are good it doesn’t cover very much. To check how much a comprehensive plan would cost you, go to ehealthinsurance.com, enter your location, gender, and age as prompted, and look for the most costly of the plans that pop up. It is probably the most comprehensive.
No coverage for important things
If you don’t see a medical service specifically mentioned in the policy, assume it’s not covered. We reviewed policies that didn’t cover prescription drugs or outpatient chemotherapy but didn’t say so anywhere in the policy document—not even in the section labeled “What is not covered.”
Ceilings on categories of care
A $900-a-day maximum benefit for hospital expenses will hardly make a dent in a $45,000 bill for heart bypass surgery. If you have to accept limits on some services, be sure your plan covers hospital and outpatient medical treatment, doctor visits, drugs, and diagnostic and imaging tests without a dollar limit. Limits on mental-health costs, rehabilitation, and durable medical equipment should be the most generous you can afford.
Limitless out-of-pocket costs
Avoid policies that fail to specify a maximum amount that you’ll have to pay before the insurer will begin covering 100 percent of expenses. And be alert for loopholes. Some policies, for instance, don’t count co-payments for doctor visits or prescription drugs toward the maximum. That can be a catastrophe for seriously ill people who rack up dozens of doctor’s appointments and prescriptions a year.
Random gotchas
The AARP policy that the Clausens bought began covering hospital care on the second day. That seems benign enough, except that the first day is almost always the most expensive, because it usually includes charges for surgery and emergency room diagnostic tests and treatments.
from:
Consumer Report May 2009
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