Making The Most Of Your Health Insurance Without Breaking A Sweat

What makes a good health insurance plan? You probably know the important things. Having a network of doctors and providers you want to see (or that you already have). Decent prescription drug coverage. Low co-pays and co-insurance. But how do you save money once you have a good plan?

Whether you have coverage from your employer or you have individual coverage, making the most of a good plan may take a little bit of planning, but you’ll save and feel better while doing it.

Shop Around For Coverage and Options

Shopping for coverage seems simple enough – especially if you have an individual plan. But even with a group (employer) plan, you (usually) have options to choose from. Here are a few things to look for to save.

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Higher Deductible Plans

Higher deductibles do mean more money out of your pocket when you receive care, but it also means lower premiums. If you are in good health and aren’t concerned about the deductibles, this can save you a substantial amount. Many high-deductible plans include discounted rates for doctors and other healthcare providers.

Health Savings Accounts (HSA)

Health savings accounts are available to people with high-deductible plans. They have been compared to 401(k)s for health care because they allow you to put money away before its taxed. These pre-tax dollars are used for health-related expenses – like paying for deductibles.

Unlike Flexible Spending Accounts, HSA accounts allow you to roll-over funds from one year to another.

Flexible Spending Accounts (FSA)

Flexible spending accounts allow you to allocate a certain amount of pre-tax dollars to use for qualified medical expenses. The maximum amount in 2015 is $2,550 for individual accounts and $5,000 for dependent care FSA’s. Qualified expenses include copays, coinsurance, prescriptions, testing and more.

Dependent care FSA’s must be used for the medical expenses of a dependent family member.

Don’t Forget The Premium Tax Credit

If you don’t have an employee plan available and you purchase your health insurance through the Health Insurance Marketplace, you may qualify for a premium tax credit. These tax credits are part of the Affordable Care Act. Eligibility depends on a number of factors including your income and family size.

Maximize Your Insurance Plan

Once you have your health insurance plan, understanding the details will help you maximize the coverage you do have. Here are a few steps to take.

Use The Network

If you have a plan with a provider network, make sure you use the providers in that network. This includes specialists, hospitals and even 24 clinics for non-life threatening emergencies. Out-of-network costs are considerably higher.

Are you traveling out of the country? You may want to consider travel insurance for your health care concerns.

Stay Out of the ER

Use the emergency room for emergencies only. Staying out of the emergency room can save you hundreds of dollars in copays, not to mention the other cost you may incur. Many areas now have after-hours clinics for those weekend coughs and minor accidents – with copays that are the same as or closer to a regular doctor’s visit. Major pharmacies including as Walgreens andCVS have added clinics to their shops – making it easier to find care after normal business hours.

Always use the emergency room if you're having chest pains, severe allergic reactions, severe trauma and other life-threatening emergencies

Put Your Foot Down

Sometimes your doctor will recommend a particular procedure or medication and the insurer will deny coverage for it. If this happens, you do have rights and can appeal their decisions. Start by talking to your doctor – he or she may be able to talk to the insurer. Next, file an appeal. Every insurance company has an appeals process – check your Statement of Benefits for information on how to file. If they deny again, file another appeal.

Find Alternative Treatments

Many conditions have more than one treatment option available. If your doctor recommends a course of action that you aren’t comfortable with or is too, ask for an alternative.

This is true for prescriptions as well. While not every drug has a generic equivalent, many have alternatives.

Remember, if you aren’t comfortable with your doctor’s recommendations, get a second opinion! Good doctors will appreciate your diligence.

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