People shopping for health insurance often consider little except different plans' premiums and deductibles. That's a big mistake, says Nancy Davenport-Ennis, especially in the individual market, where copayments and caps on coverage are increasingly appearing in unexpected places. "We're seeing policies with $150 daily copayments for radiation services," says Davenport-Ennis, cofounder and CEO of the Patient Advocate Foundation, which helps people find and pay for healthcare services. "Someone with cancer may have to pay that every day for 30 days."
Here's what else to look for in a plan:
- Annual or daily caps on specific types of care or services, like oncology care, or radiation and rehabilitation services. A $30,000 annual cap on cancer services, for example, won't get you far if you need surgery, and $10,000 in annual outpatient services isn't likely to cover a course of radiation.
- Cost-sharing requirements: copayment or coinsurance amounts and coverage limits for routine office visits, specialists, drugs, and hospital admissions. The plan may charge a $25 copayment for a visit to your primary-care physician but increase that to $40 if you see a specialist.
- Generic vs. brand-name drug coverage. "There's a clear emergence of health plans that cover only generic drugs," says Davenport-Ennis.
- Annual out-of-pocket maximum. Make sure you could afford to pay whatever this figure is every year if you get sick, and remember that copayments generally don't count toward the limit.
- Lifetime coverage limit. Many serious illnesses are now considered chronic conditions rather than fatal diseases. With expensive medical treatments, a lifetime coverage limit of $1 million won't be enough for many people.