5 Ways to Get The Most Out of Your Health Insurance Plan


Health insurance is meant to protect you financially. If something happens and you require medical attention, your health insurance will cover the cost of your treatment.

This is great because you can take care of any small medical problem as soon as possible, instead of waiting for it to become a big problem. But for your health insurance to work as it should, you need to make sure that you’re getting the most out of your plan.

For a little help, below are five ways to make the most out of your health insurance.

Know What’s In Your Plan

Before determining how to use your insurance plan, it’s crucial to know what’s in it. All you have to do is simply read your plan’s coverage documents and understand each section.

Insurers must give you a summary of benefits and coverage or SBC written in plain language, which will help you understand what’s in your health insurance policy. The SBC is a document that has to be provided by all insurers to anyone who buys an individual or family health insurance plan.

The SBC outlines:

  • Coverage examples
  • Exclusions and limitations
  • Cost sharing information

If you don’t get the SBC in the mail, you can always log on to your insurer’s website or give them a call to request one. Then, when you have your SBC, start by looking at the cover page. It will tell you the name of the plan and who it covers. Plus, the dates that coverage covers.

Then take a look at each section to get more details about what’s covered under your plan. For example, the first section, “Coverage Basics,” will give you an overview of your plan’s coverage. It will tell you how much your deductible is, what percentage of medical costs are covered by your insurance (coinsurance), and whether there are any limits on what your insurer will pay out (lifetime and annual maximums).

The second section, “What’s Covered,” will give you more details about specific services that are covered by your plan. This section will also list any services not covered by your insurance.

The third section, “Cost Sharing,” will tell you how much you’ll have to pay for covered services. It includes deductibles, copayments, and coinsurance. The fourth and final section, “Other Important Information,” will provide you with information on appeals, coverage for pre-existing conditions, renewability of your policy, etc.

If you can review and understand what’s in your SBC, even if you’ve had the same insurance plan for years, you’ll be better equipped to make informed decisions about your health care. And that’s always a good thing.

Find a Good Doctor

Note that how much you use your insurance depends on whether you’re healthy. So an annual physical is a good idea to stay on top of your health and spot potential problems early.

Also, it will tell you what type of health care you may need in the future and how much it will cost you. That’s why you must find yourself an excellent primary care doctor that you feel comfortable with.

Having a doctor who knows you is crucial because they can better manage your care. They will also be more likely to catch things early and refer you to specialists if needed.

If you don’t have a primary care doctor, you’ll be going to different doctors for different things, and it will be harder to keep track of your overall health. So it’s essential to have someone familiar with your medical history who can help you make decisions about your care.

Your primary care doctor will keep you healthy and help you avoid more severe and expensive problems down the road. They can also help you manage chronic conditions and coordinate your care with specialists.

Leverage Preventive Care

Most health insurance plans, like MA or MS plans, come with preventive care benefits, which can help you stay healthy and avoid costly medical bills down the road. These benefits may include routine screenings, vaccinations, and other services to help you maintain your health and well-being.

Also, some benefits include getting screened for blood pressure, cholesterol, and diabetes. Even if you think you’re healthy, it’s essential to take advantage of your preventive care benefits and get these screenings done.

It’s better to be proactive about your health and catch any potential problems early rather than wait until they become severe and expensive to treat. So, if you have health insurance, be sure to take advantage of your preventive care benefits!

Strategically Plan Appointments and Procedures

Of course, you can’t plan for emergency procedures like an appendectomy. However, you can plan the timing of more elective surgeries and procedures, such as joint replacements.

Health insurance plans generally have a deductible amount that determines the threshold in payments from the insured person before the health insurance company starts to make payments.

Depending on your insurance plan, your yearly deductible could be a few hundred dollars or a few thousand. But then, at the start of the year, your annual deductible resets. Plus, you have to start paying into it all over again.

If you’re planning a major medical procedure, you can schedule it to maximize your health care coverage. For example, if you know you need a joint replacement surgery, you might want to have it done early in the year before your deductible resets.

You’ll only have to pay a small portion of the surgery cost yourself, or your insurance may pay for it entirely.

Learn How to File A Claim

There will be times when a clinic or a doctor won’t bill your insurance for you. You’ll likely have to pay the entire bill yourself if this happens. And this can be a costly proposition, especially if you have a lot of medical bills.

That’s why it’s essential to learn how to file a claim with your insurance company. You should do it as soon as you get a bill your insurance company hasn’t paid.

Filing a claim with your insurance company can be a bit of a hassle, but it’s worth it if you’ll get reimbursed for the medical bills you’ve already paid.

It’s essential to keep in mind that filing a claim with your insurance company is not the same as paying your medical bills. Your insurance company will only reimburse you for the amount they think is fair. They may not reimburse you for the total amount of your medical bills.

If you have questions about how to file a claim or need help understanding your insurance policy, contact your insurance company or an independent insurance agent. They’ll be able to help you navigate the claims process and make sure that you get the reimbursement that you deserve.

Final Thoughts

Your health insurance plan is a tool that can help you manage your health care costs and maximize your health. However, you can only do that if you use it correctly and fully. That’s why you need to have a clear understanding and take the time to explore your plan and what it offers. Or else, you’ll likely end up overpaying for health care or not getting the coverage you need.


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