21 Smart Questions to Ask Your Health Insurance Broker This Year

Choosing the best health insurance plan shouldn’t feel like guesswork. Use these questions to compare your healthcare options and get clear, confident answers before you enroll—whether you’re shopping the health insurance marketplace, exploring affordable private insurance plans, or bundling health and life insurance.

1) What will my total yearly cost be—not just the premium?
Ask for an all-in estimate (premiums + deductible + copays/coinsurance) at your typical usage level and a “worst-case” scenario up to the plan’s out-of-pocket max. Knowing this helps you judge truly affordable health coverage and avoid “cheap health insurance” that costs more later.

2) What’s the out-of-pocket maximum for 2025?
Have your broker show how close each plan comes to 2025 federal limits and how that affects risk in a bad year. (Annual parameters are set in HHS payment rules each year.) Federal Register

3) Are my doctors, hospitals, and clinics in-network?
Confirm your primary care, specialists, and preferred facilities. Ask about PPO vs HMO access, referrals, and any out-of-state limitations—especially important for family health coverage plans and students.

4) How are my prescriptions covered?
Review the formulary tier, prior authorization, and expected monthly costs. Request alternatives if a drug is non-preferred.

5) What preventive care is covered at $0?
Most plans must cover certain preventive services (like many vaccines and screenings) without cost sharing; ask for the current list that applies to you. HealthCare.gov+2KFF+2

6) How am I protected from surprise bills?
Ask how the No Surprises Act applies for emergencies and certain services at in-network facilities, and what you still might owe. DOL+2Centers for Medicare & Medicaid Services+2

7) Should I consider an HSA with a high-deductible health plan (HDHP)?
Confirm you’re HSA-eligible, then compare tax savings against expected care. Know the 2025 HSA contribution limits ($4,300 self-only; $8,550 family; +$1,000 catch-up at 55+). Also verify the 2025 HDHP minimum deductibles. IRS+2IRS+2

8) Can we model a couple of real-life scenarios?
Have your broker run numbers for a routine year vs. a surgery year, so you can compare “cheap and affordable health insurance” claims to reality.

9) What are my options if I’m between jobs?
Understand COBRA (typical 18–36 months, but you pay the full premium plus fees) and when marketplace or private alternatives might be less expensive health insurance. DOL+2DOL+2

10) Do I qualify for a Special Enrollment Period (SEP)?
Qualifying life events (move, marriage, birth, loss of coverage, etc.) may let you enroll outside Open Enrollment. Ask what documentation you’ll need. HealthCare.gov+2HealthCare.gov+2

11) How do emergency, urgent care, and telehealth visits bill?
Clarify copays vs. coinsurance, virtual care rules, and whether prior authorization is required.

12) What’s covered for mental health and substance use?
Confirm parity with medical benefits and any network or visit limits.

13) How are maternity, pediatric dental, and vision handled?
Some pediatric dental/vision may be embedded on marketplace plans; adults often need separate or bundled dental plans or affordable dental coverage. Ask for dental and health insurance plans that fit your family.

14) Will this plan travel well?
If you split time across states, verify network access and emergency rules.

15) How do referrals and pre-auth work?
Know the steps before a procedure to avoid denials.

16) What supplemental insurance options make sense for me?
Accident insurance, hospital indemnity, critical illness, and other supplemental plans can cap your exposure on high-deductible designs and may be affordable supplemental insurance add-ons.

17) What happens if my income changes mid-year?
Discuss subsidy changes (marketplace), mid-year plan moves, and how to keep coverage continuous.

18) What’s the renewal outlook?
Ask about carrier rate history and whether this plan class tends to see increases. Get health coverage quotes for alternatives if rates spike.

19) How do I file a claim or appeal a denial?
Make sure you know the process and timelines—and whether your broker will help.

20) Can I bundle life insurance and health insurance?
Many families prefer one point of contact for health and life insurance, dental and life insurance, and even accident insurance coverage. Ask for quotes on insurance combinations that reduce gaps without over-buying.

21) Can you provide side-by-side comparisons?
Request a simple insurance summary including premiums, deductibles, OOP max, HSA eligibility, network highlights, and estimated yearly cost. This makes choosing the best health insurance plan (for an individual or health insurance plans for family) straightforward.

Pro tip for Florida families

If you need health insurance in Florida for family coverage, ask about statewide vs. regional networks, snowbird considerations, and whether individual health insurance plans Florida offers differ from your county’s small-group options.

Ready to compare?
We’ll build you a clean, apples-to-apples snapshot of your top choices—marketplace and private—so you can pick the best health plan for your budget and care needs. If you’d like, we can also include dental plan quotes, supplemental life insurance, and accident coverage in the same review. Get a personalized health insurance quote today.