Understanding your health plan options, knowing key terms and planning your medical needs are vital to making the best decisions. But no individuals or families have the same needs. Knowing your situation is important as enrollment periods for 2019 insurance plans are nearing. And if you’re shopping for health insurance for the first time, know this: Most plans only cover a portion of your expenses – you’ll still be shelling out cash for health expenses. And, don’t forget to budget for your monthly premium, just like you would for your phone or car payment.
Here are five tips to better utilize your health insurance:
1. Examine your status
"Look at your overall healthcare needs," said Elkin Pinamonti, Novant Health assistant director of patient access. "Ask yourself what do you traditionally use healthcare insurance for?"
If you're a relatively healthy person and don't plan on any major medical procedures, you may prefer a high-deductible health plan (HDHP), which means you pay a smaller monthly premium. You have to pay more out of pocket before your insurance begins to cover a portion of your bills.
But, for instance, if you are planning a surgery in the upcoming year, that likely could mean you'll pay all of your deductible. Or, if you have multiple young children, for instance, do you anticipate an accident or two that might land the youngster in the ER?
2. Know what's free (and use it)
Many routine services intended to keep you healthy or discover problems early are free in nearly every plan, including colonoscopies, mammograms, and vaccinations.
3. Try to limit costs
If you're suffering with a bad cold, virus or minor injury, don't immediately go to the ER. Save those visits for true emergencies.
"It costs a lot less to use a provider's office instead," Pinamonti said.
Also, utilizing free-standing clinics, if possible, for some tests like an MRI is often less expensive than having it done at a hospital. Comparison shopping can help you.
4. Watch the calendar
Keep track of what you've spent compared to your annual deductible. If you expect you’ll need an expensive procedure that will get you near or over your deductible, schedule it early in the year if possible. That way, if you need more care later in the year, your insurance will kick in and cover all expenses. And don't wait until December to schedule everything; lots of people are thinking the same way and doctors’ calendars often fill quickly.
5. Understand your plan
Pinamonti said she will occasionally hear someone say `I have insurance, why do I have to pay anything?'
Your premiums aren't "it-covers-everything" payments. They're only the starting point. Familiarize yourself with the details of the plan so you'll pick the best options and better understand issues throughout the year.
Also, be aware that sometimes there are multiple entities that may bill you following a procedure - your doctor, the hospital, radiology, anesthesia, etc.
Here are pointers on the 2019 Health Insurance Marketplace.
Health insurance glossary
Coinsurance - The percentage you must pay after you've paid your deductible. The insurance payment is only for covered services, so you still may have to pay a co-pay (depending on your plan). Example: Your plan covers 75 percent of your medical bill. The remaining 25 percent, which you're responsible for, is the coinsurance.
Copay (or Copayment) - The amount you pay to a healthcare provider when you receive services. You may pay a copay for each visit to your doctor, depending on your plan. Not every plan has a copay.
Deductible - The amount you must pay before your insurer begins to play. Deductibles are measured over your benefit period (typically one year).
Example: Your plan has a $3,000 deductible, which means you pay the first $3,000 toward healthcare services. After you've reached $3,000, your health insurer pays all remaining costs.
FSA (Flexible Spending Account) - Allows you to set aside pre-tax money for common medical expenses and dependent care. But there's a catch: FSA funds must be used by the end of the year, or they're forfeited. Use it or lose it! Some common costs that qualify for an FSA are copays, hospital fees, medical tests (X-rays and screenings), dental expenses and vaccinations. Check with your employer's Human Resources department for a detailed list.
HRA (Health Reimbursement Account) - An employer-funded plan that reimburses employees for medical expenses not covered by their company-sponsored insurance.
HSA (Health Savings Account) - An account that lets you save for future medical costs. The money put into an HSA isn't taxed when it's deposited. Funds can accumulate and rollover to the next year.
Out-of-network provider - A healthcare provider who is not part of your plan’s network. The costs associated with out-of-network providers are often higher than in-network options, or not covered by your plan at all.
Premium - Payments you make to your insurance provider to maintain your coverage. These payments are due at certain times (monthly or quarterly, for example). If you receive your coverage through your employer, the premium is often deducted from your paycheck.
Novant Health offers additional resources such as a free guide, plan comparison worksheet, and marketplace checklist at NovantHealth.org/healthmarketplace.