10 Things to Check Before Signing Up for Health Insurance

# 10 Things to Check Before Signing Up for Health Insurance

Signing up for health insurance is a commitment — usually for at least a year. A mistake now means living with that mistake for 12 months. Before you click "enroll" or sign on the dotted line, verify these ten things.

1. Is Your Doctor In-Network?

This is the single most common oversight. You find a plan with a great premium, sign up, and then discover your doctor is not in the network. Now you either switch doctors or pay out-of-network rates (which can be 2–3x more).

Action: Log into the plan's provider directory and search for your specific doctor by name. Do not assume — networks change every year. If you see multiple specialists, check all of them.

2. What Is the Total Annual Cost — Not Just the Premium?

We keep repeating this because it is the most important concept in insurance shopping. The premium is just one number. You also need to factor in:

• Deductible
• Copays/coinsurance
• Out-of-pocket maximum

Calculate your total expected annual cost under each plan you are considering using low, medium, and high usage scenarios. See our comparison methodology for a step-by-step approach.

3. Are Your Medications Covered?

Check the plan's formulary (drug list) for every medication you take. Verify: - Is it covered at all? - Which tier is it on? (Tier 1 is cheapest, Tier 4–5 is most expensive) - Are there step therapy requirements? (Must you try a cheaper drug first?) - Are there quantity limits?

A medication that costs $20/month on one plan's formulary might cost $200/month on another's—or not be covered at all.

4. What Happens If You Need Emergency Care?

Emergency room visits are expensive. Before signing up: - What is the ER copay or coinsurance? - Is there a separate ER deductible? - Does the plan cover out-of-network emergency care? (In the US, the No Surprises Act provides some protection, but verify.) - Are urgent care visits covered at a lower rate than ER visits? (Many plans incentivise urgent care over the ER.)

5. Does the Plan Cover Your Anticipated Needs?

Think about what you might need in the next 12 months: - Planning a pregnancy? Verify maternity coverage and costs. Check for waiting periods on international plans. - Need surgery? Confirm the hospital and surgeon are in-network. - Ongoing therapy? Check mental health coverage limits (number of sessions, copay per session). - Dental or vision needs? Are these included or do you need separate plans?

6. What Are the Pre-Existing Condition Rules?

If you have any pre-existing conditions: - In the US on an ACA plan: you are protected. No exclusions, no higher premiums. - On an international or private plan: check for exclusions, waiting periods, or premium loadings. - Disclose everything. Non-disclosure can void your entire policy later.

Read our full pre-existing conditions guide for detailed strategies.

7. What Is the Claims Process?

A plan with great benefits on paper is worthless if claims are a nightmare. Check: - Direct billing or reimbursement? Direct billing is far more convenient. - Is there an app? Modern insurers let you file claims, find providers, and check benefits from your phone. - What is the average claim processing time? Good insurers process claims in 5–10 business days. Slow ones take 30–60 days. - What is the insurer's claim denial rate? Some insurers deny claims at significantly higher rates than others. This data is sometimes available from insurance regulators.

8. Can You Switch or Cancel?

Understand the commitment: - US ACA plans: Enrolled for the full plan year (January–December). Cannot switch until the next open enrollment unless you have a qualifying life event. - Employer plans: Usually enrolled for the plan year. Can change during annual open enrollment or with a qualifying event. - International plans: Many are annual contracts. Check cancellation policies and penalties. - Nomad plans: Some offer monthly billing with no commitment. Confirm this before signing.

See our switching providers guide for tips on changing plans.

9. What Are the Exclusions?

Every plan has exclusions — services it will not cover. Common exclusions include: - Cosmetic surgery - Experimental treatments - Injuries from extreme sports (skydiving, base jumping) - Pre-existing conditions (on non-ACA plans) - Treatment in certain countries (some international plans exclude the US) - Fertility treatments

Read the exclusions section of the policy document, not just the benefits summary. The benefits page tells you what is covered; the exclusions page tells you what is not.

10. Is the Insurer Financially Stable?

This matters more for long-term policies and international plans. An insurer that goes bankrupt cannot pay your claims. Check: - AM Best rating (for US insurers) — A rating of A or higher indicates strong financial health. - Solvency ratio — Regulators publish this for insurers in many countries. - Market tenure — How long has the insurer been operating? Newer companies may have untested claims processes.

Bonus: Read Reviews

Before committing, search for real customer reviews of the insurer. Look specifically for: - Claim experiences (did they pay? How fast?) - Customer service quality - Issues with denials - App and digital experience

One person's experience is not definitive, but patterns across many reviews are informative.

Final Thought

Spending an extra hour on due diligence before signing up can save you thousands of dollars and countless headaches over the next year. Use this checklist, do the math, and make an informed choice. Your future self will thank you.