Health insurance coverage can be confusing, and often patients don’t know what is covered, which can lead to problems and extra expense. Following are three ways to maximize your insurance coverage and get the most for your money. Premium cost isn’t the only consideration. Many employers offer only one health insurance policy(opens in a new tab), but you do have the option to purchase coverage elsewhere. If you choose to purchase privately, look at more than the monthly premium before buying. Plans vary widely in their coverage and total cost, and some will be a better fit with your family’s health situation and desired coverage. You should consider several things when buying health insurance:

  • Coverage should be adequate for any current health issues, including paying for prescriptions, medical equipment, and services such as physical therapy and nursing care.
  • Pre-existing condition coverage varies, but normally there is a waiting period before insurance will cover those health issues.
  • Deductible is the amount you pay each year before insurance goes into effect. This may be separate from your copayment.
  • Coinsurance is the percentage you pay after insurance kicks in. This typically varies from 10–50%.
  • Maximum out-of-pocket expense is the maximum dollar amount you will pay each year. Once you have reached that amount, insurance pays 100% up to the maximum plan dollar limit.
  • Maximum plan dollar limit is the most the policy will pay. Plans may have an annual and / or lifetime maximum dollar limit.
  • Copayment is the amount you pay at the time you visit the doctor, pick up a prescription, or enter the hospital. This payment may or may not count toward your deductible.

You will also want to check whether your doctors and pharmacies are listed in the insurance company’s network of providers. If they are, your visits and prescriptions will cost less. If they aren’t, you’ll pay considerably more—and some plans will not cover any care given out of network. Read your policy thoroughly. It’s not exciting reading, but familiarizing yourself with your policy will avoid nasty surprises and extra cost and hassle later. Speaking of surprises, you might find services and products are covered that you never thought of, such as alternative treatments and over-the-counter medicine. Insurers send updated policies regularly, so be sure to read those as well, and keep the summary of benefits handy for quick reference. Double-check your policy before, during, and after you receive care(opens in a new tab). Make sure that everything you need is covered by your policy. Check whether you will need referrals from your physician or authorizations from the insurance company before you go in for care. Every insurance company has specific procedures they follow, and straying from them can cost money or time. Any time you receive care, you need to be proactive about ensuring that your doctor’s office is coding and submitting your information correctly. Afterward, carefully check all bills to see that the insurance company is paying them. Don’t be afraid to talk to the insurance company directly and do what you can to maximize your coverage.

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