What to know

  • Compare total exposure, not only premiums.
  • Verify providers and prescriptions directly.
  • Consider how the coverage works away from home.

Providers and access

List the doctors, specialists, hospitals and pharmacies you want to use. Ask whether they accept the coverage and whether referrals or prior authorization may be required.

Prescriptions

Check every prescription against the plan’s current formulary, including tier, pharmacy network, quantity limits and prior authorization. Formularies and costs can change.

Costs and lifestyle

Add premiums, deductibles, copayments, coinsurance and the potential annual out-of-pocket exposure. Consider frequent travel, seasonal residence and whether you are comfortable using a network.

  • Are my providers available?
  • How are my prescriptions covered?
  • What could a high-use year cost?
  • How does coverage work while traveling?
  • Which rules require advance approval?