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Maximize Health Insurance Benefits

Health insurance is designed to help you get the care you need, regardless of the cost. Yet, many individuals and families forgo using their health insurance out of fear of high deductibles or copays, or because they don’t completely understand the way the plan works. When you know how to maximize your health insurance benefits, you can get the most out of every dollar.

How to Maximize Health Insurance Benefits

1. Use Free Services

Some preventative care and screenings should be completely covered by your health insurance, whether you are covered by Medicare, Medicaid, or your employer’s insurance. Avoiding these preventative care measures not only means you are losing out on services that you could get for free, but it also puts you at risk. Preventative measures allow you to detect potentially life-threatening problems like cancer early on and make treatment much easier, while maximizing your health insurance benefits.

Take a look at the list offree preventative screeningsand double check with your doctor when you make an appointment. Keep in mind that some healthcare providers bundle services, so it’s important to know what you will and won’t be billed for beforehand.

2. Plan Appointments Strategically

You can’t plan for accidents or illnesses, but you can plan some regular appointments or prescription costs you will need. Planning these healthcare costs strategically can help you fulfill your deductible or out-of-pocket maximum sooner, so you pay less for all other procedures and maximize your health insurance benefits.  

Deductible amounts vary widely; they may be as low as $500 for an individual on a low deductible plan or as high as $13,300 for a family on a high deductible plan. Once your deductible is met, you pay for medical care at your coinsurance rate. This means your insurer pays for a percent of your care, anywhere between 60 and 90%, until you reach your out-of-pocket maximum, which also varies by plan. After your out-of-pocket maximum is reached, your insurer covers 100% of your care. Your deductible and out-of-pocket maximum reset every year or any time you change insurance providers.

With these timelines and amounts in mind, it makes sense to plan any appointments you know you will need at the beginning or end of the year to maximize your health insurance benefits. If you plan appointments at the beginning of the year, you can reach your deductible faster, increasing the chances of paying less for any unplanned or subsequent services. The same general principle applies for services scheduled at the end of the year; an unplanned accident could happen at any other time of the year and you’ll meet your deductible and pay less for scheduled end-of-the-year services.

3. Know Your Out-of-Pocket Maximum

Many insured Americans don’t know their health insurance deductible, much less their out-of-pocket maximum. If you know your out-of-pocket maximum and you know how much a covered procedure will cost, you can plan your healthcare appointments to pay nothing for some care and maximize your health insurance benefits for the year.

For example, gastric bypass surgery and other weight-loss surgical procedures are now covered under many health insurance policies. These procedures are also expensive, and you may reach your out-of-pocket maximum after undergoing this surgery. It makes sense to plan this surgery as early in the year as you can, and schedule any other care you need during the same year if possible.

Keep in mind that out-of-pocket maximums and deductibles apply differently to individuals and families. One person on a family plan may reach their deductible, but another person in the family may still have to pay theirs. The deductible and out-of-pocket maximum for the entire family is much higher than any individual’s. However, knowing these amounts for each person and for the family can help you maximize your health insurance benefits

4. Budget for Care

Once again, you can’t plan for unexpected accidents, but you can budget for the care that you need. If you have an expensive procedure scheduled for the end of the year, such as a cataract surgery or knee replacement, save money throughout the year to cover the costs of care. While many doctors and hospitals offer payment plans for high deductibles, you will pay some additional interest. If you can budget for the procedure throughout the year, or budget the year prior and schedule the procedure for the start of the following year, you can avoid paying any interest and maximize your health insurance benefits.

5. Price Shop

The idea of price shopping for healthcare may seem strange, but it can save you money and help you ultimately maximize your health insurance benefits. Costs of medical care vary widely between doctors and hospitals. By choosing a healthcare provider with lower costs, you’ll pay less for the care you need, whether you’ve reached your deductible or not. Many insurers give their customers online tools to compare costs of providers in their network. Consumer Reports discovered in a poll that only about 13% of Americans use these tools or are aware they even exist.

6. Use a Flexible Spending Account

Some employers offer flexible spending accounts with high deductible plans. These amounts do not carry over from year to year, so any amount unspent is simply lost. This is another reason to schedule and budget for known procedures strategically, as you can be sure that you will use up your flexible spending account amounts each year.

Do not confuse a flexible spending account with a health savings account (below), however. These two things are very different.

7. Use an HSA

A health savings account (HSA) is available for health insurance plans with deductibles of at least $1,350 for a single person and $2,700 for a a family. An HSA is a financial instrument intended to ease the burden of high deductibles. This allows individuals and families to invest money into an account solely for the use of healthcare costs, and they do not have to pay taxes on this money. Since you pay lower premiums on high deductible plans and you receive a tax break from money in an HSA, you can lower your overall healthcare costs and maximize your health insurance benefits.

There is a penalty for withdrawing HSA funds for any non-qualified reason, however these funds do not expire and they will grow from year to year, tax free, if you do not use them. Some consider HSA funds to act as an medical emergency fund as well as part of a retirement fund, since medical expenses generally increase after retirement.

8. Price Shop Prescriptions

Many name-brand prescriptions include the exact same ingredients as their generic counterparts, but the name-brands are much more expensive. When you receive a prescription, ask your doctor if a generic is available and how much it is. If your prescription isn’t covered by your insurance you’ll pay much less on a generic. If your prescription is covered under a copay or coinsurance rate, you’ll likely still pay less with a generic and maximize your health insurance benefits.

9. Price Shop Pharmacies

Just as different medications charge different prices for the same thing, so do pharmacies. Sites like GoodRx allow you to compare pharmacy prices instantly and provide coupons to give you valuable discounts.

10. Pay Cash

Paying cash allows doctor's offices and hospitals to avoid credit processing fees, billing fees, and interest, and they can pass on some of those savings to you. Some offices offer a notable discount if you pay cash. With proper budgeting, this is an easy way to maximize health insurance benefits.

11. Don’t Put Off Care

Some people assume they’re saving money by putting off care, but this isn’t the case. You pay premiums monthly to receive insurance coverage, and not using the benefits of it means throwing this money away. To truly maximize health insurance benefits, use the benefits you have and take advantage of the care you need when you need it. Putting off care will only make the problem worse over time, and simply cost you more later.


Health insurance policies can be confusing, but getting information and asking questions is the best way to maximize your health insurance benefits. Get a good understand of your deductible, out-of-pocket maximum, and providers in your plan. In non-emergency situations, ask your healthcare provider about the costs and make sure your bills are correct. With these considerations, you may save hundreds or even thousands on your medical plan.


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Posted in: Health & Wellness