(207) 861-3000 / (800) 491-8600

Shopping for Health Insurance

Here are some helpful questions to consider as you shop for health insurance.
Does the plan...
  • Charge a premium in addition to the Medicare Part B premium?
  • Charge copayments for doctor visits?
  • Pay for prescriptions? How much?
  • Charge more if I use a doctor or hospital outside the plan? How much?
  • Have maximum amounts it will pay for different services?
  • Set limits on what doctors and hospitals charge you?
  • Charge a deductible or coinsurance for inpatient hospital services, home health, or skilled nursing facility services?
  • Does the plan cover the specific medicines I use?
  • May I use my regular pharmacy?
  • Are mail-order pharmacies available?
  • What is the annual or quarterly dollar limit on prescription medicine coverage?
  • Will I have to pay more if I prefer to use brand name instead of generic medicines?
  • Is there a maximum out-of-packet cost for prescription drugs? What is it?
  • Does the plan limit the medicines it pays for to those on a list of medicines (called a formulary)?
  • Are the hours and location of its doctors, clinics, and other healthcare providers convenient?
  • Is my access to emergency care convenient?
  • Are the doctors' offices, lab, and other services convenient?
  • How fast can I be seen for urgent (non-emergency) care?
  • Is there a telephone hotline for medical advice?
  • Are my doctors in the plan?
  • Is there a selection of the doctors, health professionals, and hospitals that I might need?
  • Can I get the doctor I want? Is he/she accepting new patients under that plan?
  • Are routine physicals covered?
  • Are eye exams, glasses, and contacts covered?
  • Are dental exams/treatments covered?
  • Are programs that focus on helping members with specific, chronic conditions such as asthma, diabetes, or heart conditions covered?
Another excellent online guide called Your Guide to Choosing Quality Healthcare has been developed by the Agency for Healthcare Research and Quality, in cooperation with other agencies of the U.S. Department of Health and Human Services.