How to make the most of your health plan coverage

October 10, 2018 — Tamara Castellano

Health care and health insurance is confusing and constantly changing.  It seems cliche to say that, but it’s true.  Which is exactly why you need to understand your health plan in order to maximize the benefits.  We’ve got some tips on how to do just that.

Understand your benefits.  

If you’re a diabetic, does your plan cover an annual podiatry exam? How much will an annual flu shot cost?  If you hurt your back or knee, how many visits to physical therapy or a chiropractor are covered?  If you don’t know the answer to one or more of these questions, it’s time to spend a little time diving into what services are covered before you need them so you’re not left scrambling when you have a health issue.

Stay in-network.  

I’ll refer you to our blog about understanding insurance terms, but in-network means using a provider, clinic or hospital that is part of the plan’s preferred list of providers. You pay less for services from in-network providers because costs have been negotiated by the plan in advance. 

Use generic medication.  

I could write an entire blog about generic drugs.  But suffice it to say this:  using generic drugs could save you as much as two-thirds in prescription costs.  Generic drugs have to be approved by the FDA and are as effective as brand name drugs.  Thus, whenever possible (especially if you have a drug cap), generic drugs help you maximize your health coverage and keep your out-of-pocket costs down.

Review your Explanation of Benefits (EOB). 

 As you know from our blog, How to understand an EOB, your EOB outlines services you received, the amount that was billed and the amount that was paid.  You should always review your EOB to make sure the information is correct and accurately reflects the treatments and services you actually received.

Take advantage of annual wellness coverage.  

Most people learn—sometimes the hard way—about their benefits and coverage when they’re sick, which is not ideal.  Most all health plans, including Medicare, cover annual wellness check-up, vaccinations, etc.  Make sure you’re taking advantage of those covered services on an annual basis.  Even if you’re healthy, it’s always a good idea to check-in with your health care provider once a year—and if it’s covered, all the better.

Use telemedicine.  

Telemedicine is one of the best and most useful innovations in patient care.  No matter where you are and no matter what time of the day, you can see a health care provider using your smart phone, tablet or computer.  Telemedicine providers can treat a number of conditions (the UPREHS telemedicine provider is Doctor on Demand) and can help avoid a lengthy—and potentially costly—trip to the ER or Urgent Care.

Be aware of out-of-pocket / lifetime maximums / limit and caps.  

Simple procedures can cost substantially more than you think and health care bills can add up quickly.  You can use pricing tools (also known as transparency tools) like Healthcare Bluebook to see what the average cost is for things like an MRI or a hospital stay or lab work.  Keep in mind that online pricing tools are just a resource to give you an idea of costs. You should call and verify costs in advance whenever possible, and make sure the treatment / procedure is covered by your plan.

Topics: Q&A

Written by

Tamara Castellano

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