Simplifying Benefits

You’ve just selected your insurance for the year after carefully evaluating the coverage and benefits of each plan available (see my Simplifying Health Insurance Options article if you missed it). So, how do you make the most out of what your plan has to offer? Well, there isn’t a one-size-fits-all approach. Every plan comes with its own unique set of perks and conditions. However, there are some steps you can take to ensure you’re reaping all the benefits. ?Let’s simplify how to get the most out of your benefits this next year.

Read the fine print

It is important to understand the small but important details defining your plan. There are many, but start by first identifying how the benefit year of your plan is defined. While most plans will reset benefits period on the first of the calendar year, not all plans do. Double check to see when and how your benefits will reset for use in the upcoming year. For example, you could be eligible for your annual physical after the first of the year or you might have to wait until 12 months after your last physical.

Beyond understanding when you can use your benefits, it is important to know what your benefits will cover. Most plans will have separate components for healthcare services and for coverage like dental or vision. These plans can contain specific nuances that are important to know before going in for a checkup, so you are not surprised with a big bill. For example, your dental plan could cover check-ups and a list of specific procedures (like x-rays or fluoride treatments) with or without a deductible. However, some plans may only cover a check-up/cleaning. Understanding what is covered and how much you might be responsible for from a financial standpoint will reduce any surprises when bills might arrive.

Another important factor - ?Make sure you know your provider network when selecting care to avoid out-of-network costs. Beyond knowing who is in and out of network, it’s advantageous to know which providers are in the highest benefit tier to get the most out of your plan. Another area where you can avoid unexpected costs with your benefits is checking and understanding your pharmacy formulary so you can get the right medication at the lowest cost possible. And remember, almost every plan includes 100% coverage for preventative services when using an in-network provider.?So take advantage of this benefit and schedule any preventative health exams and screening to make the most of your benefits in 2023.

Track your benefits

So now you know how your benefits work and when you can use them. So now, as indicated above, use them! Identify the appropriate timeframe for needed services, schedule necessary check-ups and keep a log of your appointments. When was the last time you saw a dentist? When can you go for your physical? Can you see a chiropractor with your plan? Whether it’s in your cell phone or a physical calendar, it is a clever idea to log your appointments to make sure you aren’t missing out on covered services that are designed to keep you healthy and well.

If you have employer provided coverage, you may have additional benefits you aren’t aware of like fertility treatment, mental health services and chronic conditions management. Check with your HR team to better understand these benefits available to you. Medicare Advantage plans may also come with coverage for gym memberships, vision and hearing aids, over the counter medication or at home meals. Again, checking with your plans agent or HR team can help you best understand what is available to you. ?

Evaluate your needs

As life changes, so do our needs. If you track your benefits throughout the year, it’s helpful to revisit what you used in the past year to inform next year’s selection. Perhaps there are some benefits you just aren’t using as much now. Maybe there are new services you are using that could be included as benefits in other plans. Tracking and comparing with your plan overview can help better determine the most advantageous coverage for the following year.

Benefit from your benefits

Like our insurance needs, benefit needs change from one individual to another. Even then, they can also change for each person from one year to the next. Coverage for services including health, vision, mental health and dental are key determinants for insurance plan selection for many people. But once selecting your plan you need to utilize the benefits available to get the most out of your plan and improve your overall health. Perhaps your New Year’s resolution for 2023 could be to focus on health and wellness starting with understanding and using the benefits available to you.

Got an idea for a future topic of Simplifying Healthcare? Shoot me a message, I’d love to hear from you!

-Ruth