Many people focus on co-pays and deductibles rather than on bigger items like lifetime maximums and out-of-pocket maximums when choosing an insurance plan. While health insurance is certainly nice to have for regular doctor’s appointments and the occasional prescription drug, most people could afford a $200 doctor’s bill or a $50 prescription drug charge, if necessary. What most people cannot afford is the cost of a hospital stay and/or a prolonged illness. To provide some perspective, a recent routine surgery requiring a 5-day hospital stay resulted in a $20,000 medical bill; cancer treatments that did not involve hospitalization led to $50,000 in medical expenses. Imagine what a prolonged illness or condition could cost.

It is, therefore, important to understand how the many elements of health insurance fit together to provide coverage to prevent you from facing financial ruin as a result of a health problem. Some of the very important items you should consider are:

Annual out-of-pocket maximum

The most money you will have to pay in a calendar year for “reasonable and customary” care. Your insurance will pick up the costs above this amount. This is critical because, usually, when you reach this maximum, you no longer need to pay deductibles, co-pays, or other costs. Annual out-of-pocket maximums can be limited to a specific benefit (e.g., prescription drugs) or can apply to all covered services provided during the year.

Pre-existing conditions

Health conditions producing symptoms or requiring medical advice or treatment, usually within five years* before insurance begins. If you have a pre-existing condition, it can be difficult to find affordable coverage. While some plans will cover pre-existing conditions, others may completely exclude them. Certain plans will cover pre-existing conditions only after a specific period of time. It’s better to purchase insurance while you’re in good health, when you have access to coverage at lower/better rates. The coverage or exclusion of pre-existing conditions varies by state and by plan.

* Varies by state

Maternity benefits

Some policies do not cover expenses associated with pregnancy, while others simply give applicants a choice of including or excluding maternity coverage. In any case, there may be a deductible that is specific to maternity.

Condition-specific deductible (CSD)

This is a separate deductible for a medical condition the applicant has, such as asthma. These are different from condition-specific riders, which are addendums to the insurance policy that may exclude coverage for a condition (or conditions) the applicant has. In either case, these can be appealing because they may make it possible for a customer to purchase coverage at a reasonable cost, but may leave a gap in coverage that customers need to consider carefully.

Rate guarantees

Some carriers provide 12-month or 24-month rate guarantees. Others give applicants the option of paying more for a “locked in” rate for a given period.