If you’re going to spend thousands of dollars on health insurance, it’s important to make sure you are getting the most out of your coverage. Here’s what you need to know to maximize your health insurance benefits.
Maximizing your health insurance benefits before the end of the year should be a priority for you and your family. Don’t give up extra benefits just because you are busy or have forgotten about these perks.
Many people fail to take advantage of the benefits offered by their health insurer simply because they don’t know they exist. Or even worse, they end up paying out-of-pocket expenses that may have been covered by their insurances.
Insurers are required to provide you with a Summary of Benefits and Coverage (SBC), which is a brief overview of your benefits.
Some insurance companies provide a glossary of terms that you can use to decipher industry jargon, such as “deductible,” “copay,” “co-insurance,” and “network provider.” Keep this glossary handy while you review your SBC, so you fully understand what you are reading.
Use it to help cover medical costs for services such as going to the doctor, filling prescriptions, or getting emergency care. Using your benefits will help you and your family stay healthy and reduce your health care costs
More employers are establishing wellness programs. The Health Insurance Portability and Accountability Act, or HIPAA, and the ACA encourage group health plans to adopt wellness programs but also prohibit discrimination against employees and dependents based on a health factor. These programs often provide rewards such as cost savings as well as promoting good health
Many plans pay for certain tests and preventative procedures with no cost to you. Schedule these before time runs out. Mammograms, routine exams, immunizations like the flu shot, and other preventative visits are among those to schedule now. Check your insurance information and see what you can still take advantage of without any out-of-pocket fees
Out-of-pocket costs for certain procedures can be reduced or eliminated once you have met your deductible. On January 1 of each year, everything will reset and begin again. If you have been thinking about an elective procedure, check on how close you are to meeting your deductible for the calendar year.
Make the most out of your benefits by waiting until you meet your deductible to schedule non-urgent appointments. This is a great time to schedule elective procedures, get your skin checked for moles, get your eyes tested, or seek medical attention for a lingering injury. Your deductible (and out-of-pocket maximum) will reset at the beginning of each year, so don’t miss the opportunity to get these services covered while you can.
Now is the time to double check on these. You would have considered many expenses not paid for by your medical insurance plan and estimated how much you would need for the year.
This is a tax-free savings plan which helps you to pay for many medical expenses not normally covered by medical insurance. This stays with you, and there is no minimum or maximum which must be used in a calendar year. It can pay for current or future expenses like deductibles, co-insurance, prescriptions, vision, and dental care.
This type of tax-free account must be used within the current year or you lose the money you have remaining. This is an important one to focus on. The benefit of an FSA is you can use the money for a procedure even if the money is not yet in your FSA. You contribute an equal amount from each pay period throughout the year.
Laser vision correction is commonly used in an FSA. Some employers give a grace period to use an FSA, so check with your administrator if you are not sure.
If you are lucky enough to have an employer who provides an HRA, remember the account is only active as long as you remain with that company. It does roll over, but you might consider using the remainder in the account if you plan to change jobs in the near future.
Check with your employer about what funds you have remaining if you are not sure.
One way to maximize your coverage is to stick to in-network healthcare providers since an out-of-network physician will charge more for their medical services. Make sure all of your physicians are part of your insurance company’s network so you don’t end up with a surprise bill.
Many insurance companies offer discounts and special health-related programs to their policyholders. For example, health insurers often partner with fitness centers to offer policyholders discounted monthly membership rates. Insurers may also give policyholders exclusive access to apps or online portals that contain valuable educational resources.
You may need to change your health coverage following certain life events such as marriage, divorce, childbirth or adoption, the death of a spouse, or a child aging out of a parent’s health plan.
If you change employers or lose your job, you may need to find other health coverage. If you have a new job, consider enrolling in your new employer’s plan. Whether starting or losing a job, you may be eligible to special enroll in a spouse’s employer-sponsored plan or through the Health Insurance Marketplace.
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