Strategies to help you get the most out of your benefits plan

January 10, 2023 in Health finance

Here’s a new resolution for this year—make a plan to get the most out of your benefits. While most people understand the basics of health insurance and other common benefits, far fewer know how to ensure they’re taking advantage of everything their plan has to offer and how to get the biggest benefit out of their plan. These strategies are a great place to start.

  • Read your health insurance plan documents. The amount of paperwork that comes when you sign up for health insurance, either through work or the health insurance marketplace, can be daunting. But reading through the plain language summary of benefits and coverage to learn what is and isn’t covered by your plan, how much you’ll pay out of pocket, how to find healthcare providers in your network, and what other benefits your plan includes (like the services of a case manager, wellness perks, and access to expert second opinions) and how to access these benefits can help you both get the care you need and save money. If there are things you don’t understand or have questions about, talk with the benefits specialist at work, your insurance broker, or call the insurance company’s customer service line.
  • Check to make sure providers are in your network. When you receive care from healthcare providers and facilities that are in your plan’s network, you’ll save money. You can check the list of in-network providers through your insurer’s website or call the insurer’s customer service line. You can also talk with the billing specialist at the provider or facility’s office to double check that they are in-network. Of course, there may be times when you want to go outside your insurance network, for example to see a specialist for a rare or complex health condition. Ask your insurer about how special situations like these are handled and whether you can get authorization for care from these providers to be covered at in-network rates.
  • Schedule preventive and specialist care appointments strategically. Many preventive care services, including an annual check-up, immunizations, and certain cancer screenings, are covered with no co-pay or out-of-pocket cost. Check when you’re eligible to get this important care and call to schedule an appointment sooner rather than later since many providers are extremely busy and booking appointments several months out. If you want to make a non-urgent appointment with a specialist, like a dermatologist or ophthalmologist, or schedule a non-emergency elective procedure, schedule those appointments after you’ve met your annual deductible so you’ll pay less out of pocket.
  • Choose generic medications and medications in your plan’s formulary. Generic medications often cost a fraction of their name-brand equivalents, so if you take medication, talk with your provider about the pros and cons of using the generic. Most insurance plans have a list called a formulary that outlines what medications the plan will pay all or part of the cost of. You can find the formulary on the insurer’s web site and share it with your provider to help manage your prescription costs. Most plans also have a mail order pharmacy option for medications your take regularly. Check to see if this option will help you pay less.
  • Don’t overlook discounts and special programs included in your benefits. Talk with your benefits specialist at work or check your insurance company’s web site to find out if there are discounts on wellness services like gym memberships, stress management programs, health and wellness tech (like smart watches, blood glucose monitors, and blood pressure monitors), or other perks. Also find out if there are health and wellness resources and services, like online information and education portals, virtual second opinions, online mental health services, or health navigation services to help you access the care you need.