How to Make the Most of Your Healthcare Coverage

Health Insurance

January 31, 2017

For many people, the new year brings a new health plan into play. With January wrapping up at the end of the week, it’s time to start thinking about how you’ll use your new health insurance coverage throughout the year. Even those who aren’t new to the insurance game will benefit from tips on how to maximize your plan. Whether you got a plan from an Obamacare marketplace, a private insurance broker or your work’s HR department, you should know how to get the most out of the money you spend.

Every type of insurance has stipulations that can be used to an enrollee’s advantage, but a lot of insurance owners don’t know how to find those stipulations. If you’ve been buying coverage for years, then you may also fall into the trap of assuming certain features and benefits – or not realizing that you’ve got new features and benefits – when you change plans or sign up with a new company. Take a look at your health insurance plan for 2017 to jumpstart a healthier new year.

Check for Freebies

When the Affordable Care Act changed Medicare, it added free annual screenings for mammograms and colonoscopies. You also get one free wellness visit to your primary care physician each year to check on your overall health. Use these checkups and screenings to stay on top of your health. About 40 percent of adults will get diagnosed with cancer at some point in their lives, and the earlier you catch it, the better your prognosis in most cases.

If you read your own insurance plan closely, there may be stipulations that allow you free or discounted visits to your doctor for specific reasons. The ACA also required annual wellness visits to your primary care doctor to be covered at no co-pay, no matter what kind of major medical coverage you have. Insurance plans have dropped co-pays for lab tests as well, which means you can get a yearly workup for nothing out of pocket, even if you have a high-deductible policy.

Were you given vision coverage cards along with your regular health insurance cards? You should check out your vision plan because many vision plans offer free eye doctor appointments and significantly discounted glasses. If you’re not using the freebies offered by all of your health insurance plans, then you’re not making the most of your covered benefits.

If you purchased an ACA-compliant health plan, then you still get a list of preventive services for free. While you can’t count these services against your deductible, the benefit is that you don’t have to pay for them out of your own pocket. You may not realize that your high-deductible Obamacare plan does offer a wide variety of free services and features.

Know How Specialists Work

Health plans typically cover visits with specialists as long as you get a referral from your primary care doctor, but some types of plans don’t cover any out-of-network services, like HMOs. For plans that won’t automatically cover specialists, there is a process you can go through to get your specialist visit covered. Ask your provider before seeing someone who’s out of network.
It’s important to review your health plan and know how your insurer treats specialists. Your primary doctor may not know how the process works before she tells you to go see her preferred endocrinologist, for instance, and you may end up getting billed for the full cost if the visit isn’t covered. Instead of incurring a lot of money in out-of-pocket expenses thanks to an unintended error, know what questions to ask of your primary doctor to make sure you’re seeing a specialist who is covered. Here are some questions to ask:

  • How will this specialist benefit me? You should always ask why you’re being referred to someone else, especially if you have a condition like cancer, which requires specific medical attention.
  • Is this specialist covered under my health plan? This may be a question that you need to ask your insurance company directly.
  • How will you coordinate my care with the specialist? Knowing how many doctor’s visits you can expect, how often you’ll need treatment and other factors related to your care can help you estimate co-pay and coinsurance amounts ahead of time.

Keep in mind that many doctors don’t understand the paperwork and insurance billing aspect of their practice since they’re focused on patient care, so check with the staff at your doctor’s office instead. There’s usually a person or team responsible for billing and insurance issues. Find out if you need to fill out any forms yourself, and follow up with the office to ensure that everything’s been done before your appointment.

Negotiate Costs

If you’ve ever gotten a hospital bill without an itemized list of charges, then you understand the frustration that comes from paying for services you aren’t quite sure about. Some hospitals are more upfront about their charges than others, but you have a right to ask for an itemized list – and to negotiate those charges. Medical providers don’t have to reduce costs for you, but many will, especially if you’re paying cash for treatment or you have a high-deductible ACA plan. It’s not mandatory for providers to negotiate, but it doesn’t hurt to ask. You might save a significant amount by asking if there are cash discounts upfront.

Even if you can’t negotiate lower health costs with your provider, you can still ask about payment plans and other options to help you pay for the services that come out of your pocket. Some hospitals participate in specific credit arrangements with companies like Care Credit, which cater to people who need help paying for medical care. Other hospitals accept installment payments to help ease the burden of paying hundreds or thousands of dollars all at once. Unpaid medical debt is the number one cause of bankruptcy in the U.S. Before you get overwhelmed with enormous bills, know that there are options for getting care and staying out of debt.

Understand the Fine (and not-so-fine) Print

Once you’ve paid your deductible, does your plan require co-pays or is your insurer using the co-insurance format? Many people cannot answer this question for two reasons. First, you might not have read your plan closely enough to know what happens after the deductible is paid. The other reason consumers don’t know the answer to this question is that they don’t know the difference between co-pay and co-insurance.

A co-pay is a set amount you pay for each service or medication after you have taken care of your deductible. For instance, some plans charge $20 to see your primary care doctor if it’s not an annual wellness checkup. Co-insurance means that you would be responsible for a certain percentage of your medical bills after you pay your deductible, and the insurance company pays for the rest. At a hospital, for example, you might pay 20 percent of the costs after you meet the deductible upfront. It’s critically important for you to read and understand your plan before you use it. When you understand how your plan works, you can stay on top of your healthcare costs throughout the year.

Get Help When You Need It

This might seem like obvious advice, but if you’ve got a health problem or something you’re worried about, get help as soon as you can. No one likes to miss work or life for a doctor’s appointment, but a trip to your primary care doctor for a suspicious lump or unexplained cough might save you years of treatment – and hundreds of thousands of dollars – over the course of your lifetime. Young adults aged 18 to 34 are particularly averse to checking in with a doctor’s office, but this is a bad long-term strategy. You’re paying for health insurance. Use it when you need it.

Health insurance exists to protect you and your family goes wrong, but it’s also a good way to maintain healthy habits throughout your life. Seeing a doctor regularly can do a lot to prevent certain conditions, like high blood pressure, diabetes and asthma, from getting out of hand. The old adage about a pound of prevention is true in the medical community, and it’s true to your wallet, too. If you want to get the most out of your health insurance, then you need to spend time reading and understanding your policy. The more that you know about your coverage, the more you can get out of it.