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Get the most from your health plan

You’re likely spending thousands of dollars a year on health insurance (based on US averages), so it’s important to make sure you get the most from your coverage.

Yet many people aren’t taking advantage of the benefits offered by their health insurer simply because they don’t know they exist. Or worse, they end up paying out of pocket for things that may have been covered by their insurance.

You might be surprised by all the benefits that come with your health plan. These days, most insurers offer resources designed to make your life easier, healthier, and less expensive — it’s up to you to use them! Here’s how to max out all the perks your plan may provide.

  • Know how your plan works. The first step to maximizing your plan is understanding it. And fortunately, you have access to a Summary of Benefits and Coverage (SBC), which provides an overview of what’s covered and how your costs are determined. Look for your plan’s SBC on this website or ask your insurance company for a copy. Use a glossary of terms as you review the SBC so you fully understand what you’re reading. Keep in mind that different types of plans work a little differently. Watch this video to learn more.
  • Activate your member account. Nearly all health insurers offer a secure member portal, which puts all your plan’s benefits at your fingertips. Most also offer a mobile app for added convenience. These tools make it quick and easy to review your coverage details, find care nearby, view a digital copy of your ID card, compare costs, access educational resources, learn about programs and perks available to you, and much more.
  • Choose in-network providers. A simple way to maximize your coverage is to stay in your plan’s network since going out of network will almost always cost you more. Most health plans offer an online directory of in-network providers and facilities. Use it to make sure all your physicians are part of your plan’s network so you don’t wind up with a surprise bill.
  • Schedule your free preventive care. Take advantage of preventive services that are fully covered when you stay in-network, including annual checkups, routine cancer screenings, and vaccinations. Scheduling these appointments with your primary care doctor can help you achieve good health and prevent problems before they arise.
  • Pick the right place for care. You might not even need to leave the house. Telehealth services — such as virtual doctor visits and 24/7 nurse lines — are a popular choice, especially with the COVID-19 pandemic (log in to your plan’s website to check availability). Telehealth is great when you need fast, affordable care for common health care concerns that arise at any time of day or night. If you have a life-threatening situation, seek emergency care at the nearest hospital or call 911. If your health need is immediate but not life-threatening, going to an urgent care center instead of the ER will save you a lot of time and money.
  • Max out any discounts, programs, and benefits. Many health insurers now offer health and wellness benefits, such as discounts on fitness classes, support programs for specific medical conditions, apps to help you track medications and health records, and other valuable perks. Check your plan’s website regularly for new benefits.
Sources:

““7 Tips to Get the Most Out of Your Health Insurance,” Parents Magazine (parents.com)
“Tips to Help Make the Most of Your Health Plan in 2021,” North Forty News (northfortynews.com)
“Maximize Your Health Insurance Benefits,” Rocky Mountain Health Plans (rmhp.org)
“A Guide to Health Insurance Terminology,” GoodRx (goodrx.com)