10 health insurance questions to ask your new employer

by Kaiser Permanente |
People working side by side in an office

For many people, a self-initiated job change is primarily about the role you’ll have and the pay you’ll receive. But the type of health insurance options available should also be a key factor when you’re considering a job offer. Health insurance can get pretty complex at times, so we’ve put together a list of the top questions you should ask. You’ll get guidance on questions on the following topics:

  • Plan types like HMOs and PPOs, plus dental and vision coverage
  • Waiting periods
  • Costs of employee and family premiums contributions, copays, coinsurance, and deductibles
  • Providers and networks
  • Where you’ll be covered if you’re travelling
  • Coverage for pre-existing conditions
  • Coverage for dependents and spouses
  • Flexible spending accounts (FSAs) and health savings accounts (HSAs)

Is it an HMO or a PPO?

It’s important to ask about plan types because you want to make sure you’ll be able to choose a plan that aligns with your budget and other needs you may have, like a doctor or specialist you want to continue seeing. You may be able to check with state regulators about whether there are quality rankings of the various plans.

Deciding between a health maintenance organization (HMO) plan and a preferred provider organization (PPO) plan often comes down to what’s most important to you: cost versus flexibility versus the quality of care.

An HMO plan might be right for you if it has good quality ratings or if you were previously a member of the same plan and have an established relationship with the providers. If lower costs are more important, review the list of available doctors and hospitals within the HMO’s network and see if you’re happy with the selection.

A PPO plan might be right for you if it’s the only option that covers your doctor or team of specialists that you want to continue seeing. A PPO plan typically has higher out-of-pocket costs than an HMO plan. There are typically higher out-of-pocket costs for non-network providers as well — be sure you understand how the provider network works.

Is there a waiting period?

If there’s a waiting period before your new employer’s health insurance will cover you, you may be able to continue your previous employer’s insurance through COBRA, or you may want to choose a plan through a health insurance marketplace. Your spouse’s or partner’s plan may be able to cover you temporarily as well.

Will I pay a monthly premium?

Generally, employers pay the premium for employer-based coverage, and most require employees to contribute a portion of the premium cost. Ask your employer how much they will require. It may cost more to cover your family than to cover just yourself. Most employers deduct the premium contribution from your paycheck, and it applies even if you never go to a doctor. This is the amount you pay to have coverage even if you don’t use it.

You’ll also want to make sure the monthly premium works for your budget, but there’s a bigger picture to keep in mind here: Sometimes you may be offered a choice of lower monthly contributions for a plan with a higher deductible, or higher premium contributions for a plan with a lower deductible or other out-of-pocket costs. Premium contributions may also vary based on the plan. Keep in mind how you can best balance premium contributions, deductibles, and other out-of-pocket costs for your budget.

What are the copays, coinsurance, and deductibles?

This can get pretty involved but, simply put, these out-of-pocket costs determine how much you will pay for each covered service you receive under your plan.

Familiarize yourself with these terms when you’re getting ready to ask questions:

  • Deductible: The set amount you must pay during a plan year for certain services before your insurance begins to pay.
  • Copay: The set amount you pay for certain covered services or prescriptions. For example, a $30 office visit copay means you’ll pay $30 for each office visit.
  • Coinsurance: The percentage of charges you pay when you receive certain covered services. For example, a 20% coinsurance on a $200 procedure means you’ll pay $40 for that procedure.
  • Out-of-pocket maximum: The maximum amount you’ll pay for most services covered by your plan each year. After you reach this amount, your insurance will provide most covered services at no cost to you for the rest of the year.

Ask about specific benefits that are important to you or your family. Note that if a plan is self-funded by the employer, it may not provide the same coverage as traditional insurance plans licensed in your state.

Are dental and vision coverage included?

If your previous jobs have provided dental and vision coverage, you might assume that your next job will too, but it’s always a good idea to ask. Not all employers provide dental and vision insurance.

If you’re considering a job that doesn’t provide dental and vision coverage, you have some options:

  • If an HSA or FSA is available, you can use funds from those accounts to pay for dental or vision care.
  • Choose a private or discount dental and/or vision plan.
  • Pay for dental or vision care out of pocket.
  • If you’re 26 years old or younger, your parents might be able to add you to one of their policies.

Skipping dental or vision checkups isn’t worth the limited savings. Keeping up with basic preventive care helps keep your health care costs down in the long run.

What are the healthcare providers and networks I can use?

This question is especially important if you currently have a doctor or team of specialists you want to continue using. Ask which providers and networks are included in the available insurance options. Get the name of those insurance options, and call your current doctors to confirm they accept those health plans. You may be able to check with state regulators about whether there are quality rankings of the various plans.

Where will I be covered?

Will you be traveling a lot for work, or do you travel often to visit family? Make sure you understand how much medical care the plan you choose covers in another state or country. The majority of plans will cover emergency and urgent care anywhere in the world, but it’s important to obtain these details just in case.

Will it cover pre-existing conditions?

If you have a pre-existing condition that requires medication or ongoing specialist visits, confirm if and how it will be covered by the insurance plans you’re considering.

It’s also a good idea to ask for a list of prescription drugs that are available under the plan so you can see how they’re covered and what they’ll cost.

Will it cover dependents or my spouse?

If you’re in a relationship or raising a family, it’s common to cover a spouse, partner, or dependents on one person’s plan.

If a new employer only offers health insurance to employees, see if your spouse or partner has the option to add dependents (or even you) to coverage offered through their workplace.

Do you offer an HSA and/or FSA?

Choosing an HSA or FSA is a great way to reduce your tax liability and save for anticipated expenses like medicine, prescription eyewear, and medical procedures. You can use the savings in these accounts to pay for hearing, vision, and dental expenses, even if you don’t have insurance for them.

In summary

Think of this list as just a top 10 of the many questions you can ask — and should ask — as you’re considering a new job and evaluating health plans.

Many HR departments have helpful documents that let you see plan details side by side so you can compare them and find the plan that’s right for you. These documents should also outline other health-related perks that you might not expect, including massage therapy, acupuncture, and even pet insurance.

Your new employer’s HR department will want to help you make the right decision the first time, so don’t shy away from asking them about what you need to know.

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