How To Make The Most Of What Your Healthcare Provider Has To Offer 

Updated on December 18, 2019

While cancer, workplace accidents, and chronic diseases may frighten you, here is something even more terrifying: According to a survey conducted by Maestro Health, 35% of American employees don’t understand their healthcare coverage. Even worse, an additional 33% claimed they don’t fully understand their medical bills. 

Our bodies are amazing, but sometimes they fail. And when they do, it’s vital to have a sufficient healthcare plan that can cover the costs.

Regardless if you are single or have a family, you need to know who your healthcare provider is and what your plan covers. If you want to get the most from your health insurance, you must first educate yourself.

Understand Your Plan to Get the Most out of Your Healthcare Provider

To make the most of what your healthcare provider has to offer, understand the basics of your plan. Refer to your healthcare benefits, consider your out-of-pocket costs, use your deductible to your advantage, identify the best in-network providers, and get long-term prescriptions in bulk. These tips work to your advantage to save you money.

1. Get a Comprehensive List of Benefits

First things first, learn the benefits your plan provides. When you first signed up for your health insurance, your provider should have supplied benefit documents. Keep those handy, so you can refer to them from time to time.

Your benefits package lists how much you must pay for different types of services, as well as the rules of your plan. It outlines how your insurance covers visits to specialists and when you need referrals to receive your coverage.

The Affordable Care Act (also known as Obamacare) made it mandatory for healthcare companies to cover ten essential benefits. These include:

  • Outpatient care (also known as ambulatory services)
  • Prescription drugs
  • Preventative care
  • Laboratory services
  • Pediatric services for children
  • Emergency care
  • Hospital coverage for surgery and overnight stays
  • Mental health services
  • Rehabilitative care
  • Pregnancy, maternity, and newborn care

Most importantly, your benefits package should list what your healthcare provider does not cover. It’s vital to know your health plan’s limitations to make sure you’re sticking with a provider that best fits your needs.

2. Consider Out-Of-Pocket Costs

Health insurance doesn’t mean you get to enjoy a free trip to the doctor. Health insurance shares cost with you until you reach your out-of-pocket limit. Once you have surpassed that number, your healthcare provider should cover the remaining medical expenses.

Your health insurer should have included your out-of-pocket costs in its benefits. For most plans, the higher premium you pay, the higher your out-of-pocket costs will be. Out-of-pocket expenses are essential for you to know if you want to make sure you’re on the right healthcare plan. 

For some, getting the most out of their healthcare plan means paying a higher monthly premium so they can enjoy lower out-of-pocket costs. This type of health insurance is ideal for someone who:

  • Sees physicians and specialists frequently
  • Is at risk of emergency care
  • Takes brand-name medications regularly
  • Is pregnant or planning on starting a family
  • Has a surgery or series of surgeries coming up
  • Has a chronic condition that requires constant medical care

For example, a patient suffering from Gastroesophageal Reflux Disease, a chronic condition that affects over 15 million Americans daily, would benefit this type of plan. Paying a higher premium with lower out-of-pocket costs means they don’t have to worry about affording ongoing GERD treatment.

For others, a more appropriate healthcare plan includes one with higher-out-of-pocket costs and lower monthly premiums. People who are in good health, do not have any chronic medical ailments, and rarely need to see a doctor get the most out of this type of plan.

3. Make the Most of Your Deductible

In regards to your healthcare plan, a deductible is an amount you pay before your insurance plan covers costs. Most plans will cover regular services without meeting your deductible. Some plans include separate deductibles for specific services, such as prescription drugs.

To get the most out of your healthcare plan, be aware of your deductible, and how it works. Once you’ve maxed out your deductible, your healthcare provider is responsible for covering your medical expenses. Use this to your advantage.

Schedule appointments that may not be emergencies, but are important to your health. This includes dermatology visits and eye checkups. If you visit these specialists before maxing your deductible, you will have to pay more for your visits.

Keep in mind your deductible depends on your specific healthcare plan. Understanding your plan is the key to getting the most out of your deductible.

4. Know Your In-Network Providers

Your insurance company should provide you with a list of in-network providers. These are doctors and hospitals that participate in your insurance network. Working with them means lower copays and medical costs.

If you don’t know what doctors are part of your in-network providers, contact your healthcare provider. They should be able to provide you specific names, companies, and locations.

5. Get Prescriptions in Bulk

For prescriptions that you or your family take on an ongoing basis, buy in bulk. Ordering long-term medications through the mail on a subscription service through your healthcare provider saves time and money.

Pharmacies can issue supplies that cover up to 90 days at a time, which means lower dispensing fees and less out-of-pocket costs. If you take birth control or other daily pills, consider ordering them in bulk through a mail-order subscription.

Explore the Latest Healthcare News

Healthcare is an industry that is often in the spotlight. To ensure you’re getting the most from your healthcare provider, understand your plan, and stay updated on the federal healthcare policy changes that could affect you.

We work around the clock to bring you the latest healthcare updates. Explore our website to learn more about what’s trending in healthcare today.

+ posts

Throughout the year, our writers feature fresh, in-depth, and relevant information for our audience of 40,000+ healthcare leaders and professionals. As a healthcare business publication, we cover and cherish our relationship with the entire health care industry including administrators, nurses, physicians, physical therapists, pharmacists, and more. We cover a broad spectrum from hospitals to medical offices to outpatient services to eye surgery centers to university settings. We focus on rehabilitation, nursing homes, home care, hospice as well as men’s health, women’s heath, and pediatrics.