Get familiar with your health insurance: Ways to save money and maximize care

[4 MIN READ]

In this article:

• Understanding your health insurance coverage puts you in the driver’s seat and gives you the confidence to make healthcare decisions that are best for you.
• Find out what preventive care is provided, schedule appointments early and check to make sure your providers are in-network.
• Advice on maximizing your coverage and saving money.

Let’s be honest: Reading through the details of your health insurance plan doesn’t exactly sound like the most exciting way to spend an afternoon. After all, if your primary care doctor is in-network and your standard co-pay has been the same over the last couple years, what else do you need to know?

By taking the time to refresh yourself on the coverage you’ve selected (or are currently selecting), you may be pleasantly surprised to find some hidden benefits you haven’t used before, save money and get the preventive and medical care you need to stay healthy.

Read more to learn some tips and tricks that can help everyone — regardless of their plan type — maximize their health insurance.

Know your healthcare plan

When you are well-versed in your plan benefits, you can make better decisions about when and where to get the care you or your family needs. That begins by eliminating assumptions and making sure you know what your plan covers.

Here are a few questions to get you started:

• • What type of plan do you have? There are many choices for health insurance coverage, and each offers different benefits. Make sure you know whether your plan is a PPO, EPO, HMO or another type of coverage.
  • What does your plan cover? Get familiar with what you’ll be expected to pay for care. Learn about co-pays/coinsurance for providers and specialists, deductibles, out-of-pocket costs and other coverage details. This will help you understand what you may have to pay after you receive care.
  • What are your benefits? Look through the “Summary of Benefits and Coverage” to get a comprehensive snapshot. Then, review areas of care you may need throughout the year, like urgent care, emergency care and preventive care.
  • What are your prescription benefits?  In addition to using in-network pharmacies, some plans offer discounts for using a preferred mail-order pharmacy. You’ll likely also save by using generic instead of name-brand prescription medications.
  • Does your plan include dental and vision? Dental and vision are typically offered as supplemental plans but be sure to review those benefits as well. That way you’ll know where to turn for your next dental checkup, braces for your child or glasses for your spouse.
  • Know your rights. You have the right to fair and easy insurance coverage. That includes coverage for pre-existing conditions, free preventive care and even a translator if you don’t speak English.

Know your provider network

Your plan’s network is a group of doctors and providers that have agreed to bill a certain amount for care. Doctors, providers and specialists who are “in-network” typically charge you less for care.

A provider who is “out of network” may not be covered at a lower rate, or not at all, resulting in you paying a much larger out-of-pocket cost. Don’t rely on the receptionist at your doctor’s office to know whether the specialist they are referring you to is in-network for your plan. Always do your research by consulting the provider directory or calling the informational number on the back of your insurance card.

Take advantage of preventive care benefits

Staying on top of your annual wellness visits helps you stay well and live your best life. These benefits are at no out-of-pocket cost to you, as required by the Affordable Care Act (ACA), whether your plan is employer-provided, purchased on the marketplace, Medicare or Medicaid. Regardless of your coverage, preventive care benefits may include:

• • Annual physical
  • Well-woman visits for women under age 65
  • Well-baby and well-child visits, up to age 21
  • Diabetes screening
  • Blood pressure screening
  • Cancer screenings for some age groups (mammograms, Pap tests and colonoscopies)
  • Routine vaccinations

Learn more about covered preventive services.

Schedule preventive care early in your coverage year

Take advantage of the preventive services covered at no cost to you early in the year, or soon after your coverage becomes active. Although you may not want to think about your doctor discovering a health condition or recommending surgery, the reality is that some years you or your family members will need more care.

You may also want to check your coverage to learn if benefits vary based on in-person visits or virtual care. Some plans offer more convenient scheduling and different copays for virtual care to encourage social distancing.

Manage chronic conditions

If you have a chronic condition like diabetes or high blood pressure, your health plan or employer may offer unique benefits to help you stay healthy and reduce the risk of complications. These may include:

• • Diabetes counseling
  • Regular blood pressure screenings
  • A wellness coach
  • Discounts for gym membership

Find out how to use healthcare accounts

Your plan may allow you to set money aside to help cover healthcare related expenses. Be aware of how you are setting aside money and how to access those funds when you need them. Some employers may offer contributions. Check your balances often and be aware of how much you have available to spend. The most common accounts include:

• • Flexible Spending Account (FSA): This account allows you to set money aside on a pre-tax basis that you can use throughout the year to pay for certain out-of-pocket healthcare costs like prescriptions, office visits and procedures. The flexible spending account is generally “use-it-or-lose-it,” meaning you must use the funds within the calendar year, unless your plan offers a rollover feature.
  • Health Savings Account (HSA): HSAs are offered with plans having higher deductibles, referred to as a high-deductible health plan (HDHP). An HSA allows you to set aside tax-deferred money to save for healthcare expenses, like copays and coinsurance or even IRS approved expenses not covered by your health plan. The money in your HSA is yours to keep and access at any time to pay for healthcare expenses, now or to save for the future including retirement.

Q. Are there benefits that people generally don’t utilize?

A: People with chronic conditions really need to stay on top of their care. They need to plan early so they can live their best lives. Don’t be afraid to reach out to ask questions. You may qualify for care management to assist you. There may also be some things like naturopath services and biofeedback that may be covered beyond their standard healthcare that people may not be aware of.

How can I get more information on what my plan covers?

In addition to the Summary of Benefits coverage, you will also have access to a Summary Plan Descriptions or Evidence of Coverage. You can also contact the phone number on the back of your medical ID care to ask questions before you receive care to understand what you plan covers.

Q. What if I don’t have health insurance?

If you don't have health insurance, you can get covered as soon as the first of next month by applying for a plan on the federal exchange at www.healthcare.gov. No qualifying event is required, and many patients can get a plan for $10/month or less with financial assistance.

Maximize your insurance to maximize your health

When it comes to health insurance, knowledge is power. Understanding your coverage and benefits can help you make informed decisions about the care you receive. It helps put you in the driver’s seat for your care and your good health.

Insurance benefits can vary greatly between individuals. Your coverage will depend on your situation, such as: the plans your employer offers; whether you purchase insurance through the marketplace; Medicare or Medicaid coverage; and many other factors. The advice in this article is general, but please consult with your plan administration or insurance representative to answer any specific questions you may have.

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About the Author

The Providence Body & Mind Team is dedicated to providing medically-sound, data-backed insights and advice on how to reach and maintain your optimal health through a mixture of exercise, mindfulness, preventative care and healthy living in general.

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