Six Steps to Maximizing Your Health Coverage

To get the most out of your insurance plan, it’s important you have a comprehensive understanding of the plan itself, its network, and the benefits offered. Read on for six steps you can take to reap the biggest rewards from your plan and better manage costs.


1. Review your plan online

Whether you’re purchasing an insurance plan or renewing an existing one, familiarizing yourself with your plan’s benefit design is a great way to set yourself up for success. Study up on the basics like:

    • The Schedule of Benefits (SOB), which shows how much you have to pay out of pocket for various types of covered services and the maximum you will pay during a plan year.
    • Deductible – the amount you pay for covered healthcare services (such as $2,000 or $4,000) before your plan starts to pay.
    • Copays – a fixed amount that you pay for a covered service (such as each lab test or prescription) after you’ve paid your deductible.
    • Coinsurance – the percentage of costs (such as 20% or 50%) that you pay for a covered service after you’ve paid your deductible.
    • Preventive care benefits (like shots and screening tests) that your plan covers at no cost to you.
    • Prior authorization – preauthorization by your plan before you can receive certain healthcare services, prescriptions, or equipment (except in an emergency).
    • Provider network – where you can go to receive services that are covered by your plan.
    • Certificate of coverage (COC), which defines the benefits and limitations of your plan.

Read your plan’s coverage details every year, even if you think you know what they say. Benefits and coverage could change.


2. Take advantage of preventive care

Even a bare-bones plan will include certain preventive care services at no cost to you. For example, screenings for diabetes, cholesterol, and high blood pressure are three basic procedures generally covered. Breast cancer screenings and immunizations like the flu shot are also usually free. Some restrictions may apply, like the services must be received from an in-network provider, you must be of a certain age or gender for the preventive care services to be covered at no cost. Reading your plan documents can help clear up any confusion.

Check out our post on preventive care here.


3. Be strategic with big procedures

How quickly your plan begins paying for healthcare services depends on the size of your deductible along with the frequency and cost of healthcare services received. For that reason, it pays to be strategic when scheduling care. If a large-cost service (like a surgery) is needed and you can afford to pay for the out-of-pocket costs up front, scheduling it early in the year can help you hit your deductible sooner. However, if you don’t have the funds to cover the out-of-pocket costs for the surgery, scheduling it later in the year could be helpful.


4. Learn how to file a claim

Sometimes a doctor or clinic won’t bill your insurance for you, meaning you have to pay the full amount at the appointment. While you’re paying for the appointment, ask for an itemized receipt with the date of service and the diagnosis code. You’ll also need the right insurance claims form (it’s sometimes best to call your insurance company to ask for the correct form).

Tip: Once you have the right claims form, fill in all the information except the signature and date, then make copies or scan it. That way, if you need to file another claim in the future, all you’ll need to do is sign it, date it and mail it with the itemized receipt you got from your doctor.


5. See if your plan offers extra perks

Sometimes insurance plans offer discounts on health and wellness programs. This could include discounts on fitness classes, targeted programs to help with specific medical conditions, or other special offers. Check your insurance company’s website and your online portal regularly to stay informed about perks that are added or changed.


6. Compare your medical bill to your explanation of benefits

Other than copay, which you may be asked to pay upfront when visiting your provider, it’s a good idea to wait until you receive an explanation of benefits (EOB) from your insurer before paying medical bills. Your EOB will show the allowed amount for each covered service and any portion of the cost that you are expected to pay. If a service was denied, your EOB will explain why. Comparing your EOB to an itemized bill from your provider will help you identify a service you didn’t receive. Be sure to contact your provider’s billing office about anything that appears incorrect.


The Takeaway
Stay informed about your plan’s benefits and don’t be afraid to ask questions. Your health insurance plan is there to help you maximize your health. The deeper your understanding of its benefits, the more fully you can utilize them.

For information on the plans offered by Common Ground Healthcare Cooperative, call us at 877-514-2442.