How to Get the Most Out of Your Health Insurance Benefits

Your health insurance plan plays an important role in helping you get the care you and your family need — and can help keep costs manageable. But are you making the most of your available health insurance benefits? Here are eight tips to help you and your family get the most out of your health insurance plan.

1. Understand your summary of benefits. Review your summary of benefits, an easy-to-read document that lists the types of services your insurer will cover and how much it will pay. This may be listed as a percentage of the cost or a flat amount. Your summary of benefits may also detail tiers of health care providers within the insurer's network. The insurer may pay depending on the tier of a certain health care professional. Take the time to understand exactly what services are covered, what are not, and what your coverage limitations are. Be sure to contact your health insurance company or benefits administrator with any questions.
2. Take advantage of preventive care benefits. Many preventive services are often covered at no cost to you. Preventive services may include services such as annual physicals, vaccinations, health screenings, such as mammograms and colonoscopies, eye exams and dental cleanings. Check your health insurance plan for details and use these benefits. Preventive care can prevent bigger health problems down the road.
3. Choose in-network providers to save money. Insurance companies have agreements with certain doctors, hospitals, pharmacies, and other healthcare professionals who agree to be paid rates negotiated with your insurance company. These healthcare providers are classified as being in your network, commonly referred to as, in-network providers. Most insurance companies provide websites with online provider directories listing out the healthcare professionals who take your insurance. You'll generally pay less for services received from an in-network provider. Some insurance companies also break down in-network providers into tiers and pay more for services provided by health care professionals in the higher tiers. Look up each of your regular doctors and other health care professionals to get a better idea of how much of the cost your insurer will pay, and how much you will need to pay.
4. Maximize pharmacy benefits. Most insurers offer coverage for prescription medications. Check your plan's prescription drug list for the medications you take most often. You may have cost-effective options such as switching to a generic brand, purchasing medications via mail, or ordering 90-day supplies of maintenance medications versus 30-day supplies.
5. Compare costs. It's a good idea to get an estimated cost for tests, procedures, and doctor visits before you receive care. Check your health plan's website to see if they offer a cost estimator or contact your healthcare provider for an estimate.
6. Make the most of your deductible. A deductible is the amount you must pay out of pocket before your insurer starts paying their share for some services beyond preventive care. If you meet your deductible before the year's end, consider scheduling treatments before your current policy expired and your new plan begins. This is when everything resets. You will lose any progress you've made in meeting deductibles.
7. Check for health and wellness discounts. Many health plans offer free or low-cost wellness benefits to encourage plan holders to make good health a priority. These can include gym membership reimbursement, as well as programs to help with weight loss, smoking cessation, diabetes management, and the like. Some health insurance plans even provide incentives and rewards – often monetary – for setting and reaching specific health and wellness goals.
8. Take advantage of health insurance plan's tools and services to help you save time. If your health plan has a mobile app, take advantage of digital features like a mobile ID card and quick access to deductible and claim statuses — so you'll have your health plan information whenever and wherever you need it.

Keep in mind that the more you know about using your health insurance benefits, the better prepared you'll be to get the care you need for yourself and your loved ones — while ideally keeping out-of-pocket costs to a minimum.

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Our Experts

Patty Caballero and her team of consultants together have more than 35 years of health insurance knowledge working for some of the biggest health insurance companies in the US. She has knowledge in building brands and strategic initiatives to help consumers better understand their health benefits.