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Important Questions to Ask Your Agent When Shopping ACA Plans

When shopping for an ACA insurance plan, it’s crucial to ask your insurance agent the right questions to ensure you choose the best coverage for your needs. Here are some important questions to consider:

What are the monthly premiums and deductibles for the plan?

Understanding the costs associated with your plan is essential. Be sure to inquire about the monthly premium, deductible, copayments, and coinsurance, and consider whether these costs fit within your budget.

What is the maximum out-of-pocket limit?

This is the most you would have to pay for covered services in a plan year. Knowing the maximum out-of-pocket limit can help you understand your potential financial responsibility if you require significant medical care.

Are my preferred doctors and hospitals in-network?

If you have preferred healthcare providers, confirm that they are included in the plan’s network. Out-of-network care can be more expensive, so it’s essential to choose a plan that includes your preferred providers.

Are my prescription medications covered under the plan’s formulary?

Each ACA plan has a list of covered prescription medications, known as a formulary. Make sure to check whether your current medications are included in the plan’s formulary to avoid unexpected costs.

What is the process for obtaining referrals or prior authorizations for specialist care or procedures?

Some plans may require referrals from your primary care physician or prior authorization for specific treatments. Understanding these processes can help you navigate your plan more effectively and avoid delays in care.

Are there any additional benefits or wellness programs offered by the plan?

Some plans offer value-added services like gym memberships, telehealth services, or wellness programs. These benefits can help you stay healthy and potentially save money on healthcare costs.


Shopping for an ACA insurance plan is an essential process for securing affordable, comprehensive health coverage. By understanding the importance of purchasing an ACA plan and asking your insurance agent the right questions, you can make an informed decision that best meets your needs and protects your health.

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