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Making The Most of Your Health Insurance Benefits

Health care can be confusing — and costly. Here are some ways you can make the most of your health insurance benefits. Master these points to stay healthy and save on your health care costs.

1. Stay in-network

Your benefits will be paid at a lower rate if the doctor or other health care provider is not in your network. Make sure all doctors and other experts involved in your care are in your specific network. This means specialists (such as anesthesiologists), medical equipment and lab or x-ray testing. Out-of-network care will cost you more.

2. Get pre-authorization, if needed

To be covered, some services require pre-authorization. Find out ahead of time if the services you need have such a requirement. Your claim could be denied if pre-authorization was needed and you didn’t get it before you received care.

 

3. Know what’s covered in an office visit

Certain routine treatments are covered under the office visit copayment. But other more complex ones may be applied to your deductible (the amount you must pay before your insurance company starts to pay your claims) or co-insurance (your share of the cost of the service, such as 20 percent). Always check your official plan documents for the cost sharing amount for specific services.

4. Ask for generic drugs

Ask your doctor if a less expensive generic form of a prescription drug will work as well as a name brand for you. Your cost share will be lower with a generic.

5. Use your preventive care benefits

Routine preventive care like screenings, checkups, and counseling to prevent sickness, disease or other health problems are covered by most plans. Use these benefits for age-appropriate annual pap tests, mammograms, health exams, flu shots and more. Check your plan for details.

At your yearly wellness exam, make sure any tests done are included in the U.S. Preventive Services Task Force A and B Recommendations.

Terms to know

Although most Americans have health insurance, many of us are still stumped when confronted with health insurance terms. Getting familiar with insurance lingo can help you select a plan that works best for you — and to use your benefits wisely.

Here are a few terms you should know:

  • Premium: The amount you’ll pay each month or year to keep your insurance. Your employer may pay part.
  • Deductible: The amount you pay out-of-pocket before insurance begins paying for care. Typically, the lower the deductible, the higher the premium.
  • Co-insurance: The part of your medical bills you pay. It’s usually a percentage of all costs over the deductible.
  • Copayment: A fee owed to your doctor at each visit.
  • Formulary: A list of the medications covered under your plan and what your cost share will be. Typically grouped into cost tiers.