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Getting the Most Out of Your Health Insurance Plan

You probably pay a sizable amount every month to maintain you and your family’s health coverage, and so you want to get the most benefit out of that investment. You know that if a member of your family has a medical emergency, that health insurance policy will help you pay off medical expenses, keeping you from financial catastrophe, but there are many other considerations as well.

Your health plan has many more benefits than just catastrophic coverage, many of which you may not even know about. Many of these benefits depend on the type of health plan you choose, so you should be sure to carefully examine all of the details of a prospective insurance policy before you purchase it. Consider your responsibilities in maintaining coverage as well as the perks and benefits that a particular plan may offer.

Choosing the Right Health Insurance Plan

Every family is different.  That is why you should carefully analyze your family’s current and upcoming needs when you choose a health insurance policy.  You may need to educate yourself on the many concepts involved in making up a health plan.  For example, you may not realize the differences between a HMO, EPO or PPO type of plan; HMO plans have the narrowest network of providers but the lowest cost, while PPO plans offer a broad network at a higher cost.  If you are looking for lower premiums and your family only sees a few, well-known physicians, you probably should be safe with a HMO plan.

If finances are a major concern for you, you may need to do some math before choosing a health plan.  If you and your family are relatively young and healthy, then you might want a plan with a low premium and higher deductible. You pay more to see a doctor, but you pay less to maintain your coverage. On the other hand, if you are older and unhealthy, it might be wiser to get a higher premium with a lower annual deductible; you pay more each month, but you pay a smaller fraction of medical expenses.

Hidden Perks

It sounds illogical, but health insurers don’t want you to get sick. It may seem that insurers make money when you see a doctor, but that often is not the case.  Insurers don’t make money by insuring individuals; they make money by insuring large groups of people. They make a profit if most of the people they insure remain healthy and lose money if more policyholders are sick.  There is also a strong financial incentive to keep you living as long as possible (primarily because you are likely to stay with your insurer the longer you have paid into their network).

That is why many insurers offer perks to people if they make an extra effort to stay healthy.  That is why more insurers are making available beneficial services like educational seminars that inform people as to how to stay at optimum health.  Most insurers offer some form of program to stop smoking, eat right and exercise regularly—all habits that keep you healthy and living longer. There may be cash back rewards, cost discounts or free support groups to help you achieve your health goals.

Choosing the Right Health Insurance Plan

More insurers are also implementing programs that improve your quality of life as well as your health.  For example, this may include discounts for gym memberships, massage sessions or laser eye surgery. Some healthy living programs may offer free one-on-one or group coaching to help you better manage chronic conditions like obesity, depression or high blood pressure.

While many of these programs are promoted by insurers, others you may need to find out about on your own.  Be sure to read all the materials your insurer sends you and peruse their website to learn more about limited-time offers.  You could save a bundle or get a lot of things you really want while staying at peak health.

Included Services

In 2010, when the Affordable Care Act was passed, a number of things changed about health insurance.  The new law required that all health plans include these essential health benefits:

  • Outpatient services
  • Emergency services
  • Hospitalization including surgery and overnight stays
  • Pregnancy, maternity, and newborn care
  • Mental health and substance use services
  • Prescription drugs
  • Rehabilitative services and devices
  • Laboratory services
  • Preventive and wellness services
  • Pediatric services, including oral and vision care

Most of these services are not free, but you should find them in almost all health plans, although older health plans from before the ACA and some temporary health policies may not include all of these. That means you can count on coverage for all of these services and only consider other issues when you shop for a health plan.

Affordable Care Act

One thing you should take advantage of—because it is free—is the preventive services.  You get one annual checkup at no charge, along with many of the following preventive care services:

  • Abdominal Aortic Aneurysm one-time screening
  • Alcohol Misuse screening and counseling
  • Aspirin use
  • Blood Pressure screening for all adults
  • Cholesterol screening for adults
  • Colorectal Cancer screening for adults over 50
  • Depression screening
  • Type 2 Diabetes screening
  • Diet counseling
  • HIV screening for all adults
  • Obesity screening and counseling for all adults
  • Sexually Transmitted Infection (STI) prevention counseling for adults
  • Tobacco Use screening and cessation interventions for tobacco users

Immunization vaccines for adults:

  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster
  • Human Papillomavirus
  • Influenza (Flu Shot)
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal
  • Tetanus, Diphtheria, Pertussis
  • Varicella

Furthermore, women get some additional preventive care like HPV tests and contraceptive care. Minors are also offered services like comprehensive immunizations, autism screening, oral health, vision and developmental care.

You should notify your family physician that you want to take advantage of free preventive services when you schedule a visit.

To learn more about the many benefits of your health plan, please visit Boost Health Insurance.

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