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cialist is in the network just because your primary care doctor gave you the name.
2. You Pay Huge Insurance Premiums to Save a Few Bucks on the Copay
"The mistake I see individuals make so many times is they focus so much on getting a low copay and they fail to look at how much extra premium they pay for it," says Villemain.
He suggests you evaluate how you'll use your plan and compare the costs accordingly. If you go to the doctor only a couple of times a year, is it worth spending hundreds of dollars extra on the premium just to get a low copay?
3. The Drugs You Take Aren't Covered
Some states require individual plans to offer prescription drug coverage, but in other states, many individual health insurance plans don't cover drugs, says benefits consultant Michael Goodheim of Farsighted Strategies in Seattle, Wash.
If the plan does provide drug coverage, check to see if your medication is included on its formulary, which lists the preferred drugs for coverage, Goodheim says. Expect to pay more if you take a drug that is not listed.
Rosen suggests checking whether the plan provides discounts if you order prescription drugs in bulk by mail order. For instance, you might be able to pay less per month for a 90-day supply through mail order than a 30-day supply at the pharmacy counter.
4. You're Overinsured.
In addition to comprehensive health plans, many employers offer supplemental insurance policies, such as cancer or critical illness insurance, which pays a lump sum of cash after diagnosis. Such policies can provide valuable protection, but they might be unnecessary if you already have broad coverage under your medical insurance and short-term and long-term disability insurance, Goodheim says.
If you're footing at least a portion of the premium bill, why pay for coverage you don't need?
5. You Can't Afford Your Share of the Medical Bills
Low premiums are an attractive feature of high-deductible health plans, but make sure you're prepared to pay all the out-of-pocket medical expenses, Goodheim says.
Besides the deductible, check the maximum amount of out-of-pocket expenses you pay. After you pay the deductible, many plans pay only a portion, such as 70 percent of covered medical expenses. Your 30 percent share of the expenses is called coinsurance, which you must fork over until you reach the cap on out-of-pocket expenses.
"Those dollars can really add up," Goodheim says.
6. You're Expecting, but Your Health Insurance Plan Doesn't Cover Maternity Care
Most employer-sponsored plans cover maternity and prenatal care thanks to the federal Pregnancy Discrimination Act of 1978 and the Health Insurance Portability and Accountability Act of 1996, as well as many state health insurance mandates for group coverage. Some states also require individual health insurance plans to include maternity coverage, but in
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