Are You Taking Full Advantage of Your Health Insurance Coverage?

9/6/2024

Now is a good time to review health insurance policies to ensure you will get the most out of plan benefits, especially if you have already met the annual deductible.

Many insurance plans will cover most, if not all, costs for eligible medical procedures and treatments once an individual meets the deductible and out of pocket maximum, making the second half of the year an opportune time to schedule any necessary or elective medical procedures that may have been postponed to reduce out-of-pocket expenses.

We encourage everyone to take full advantage of the preventative care and medical services available through their health plans,” said Michael Curran, CEO of Commonwealth Health Regional Hospital of Scranton. “If you’re contributing toward your premium, it’s a ‘use it or lose it’ situation, so make sure to utilize all of the benefits you’re entitled to before the year ends and deductible and out-of-pocket payment responsibilities reset.”

For example, someone who has a $2,000 deductible and a $4,000 out-of-pocket maximum is responsible for paying for many medical expenses until they reach the $2,000 threshold. Once they pass this mark, the insurer begins paying a larger portion of the cost of services eligible through in-network providers. And when they reach the $4,000 out-of-pocket maximum, insurers will pay the total cost for eligible services.

Remember, monthly premium payments do not count towards deductibles, and in most cases, copays do not count either. And once a new policy year begins, both deductible and out-of-pocket maximum contributions return back to zero.

Dr. Rourke Decker, family medicine provider with Commonwealth Health Physician Network, highlights another critical aspect of leveraging health insurance benefits: preventative care.

“Regardless of whether your health insurance is through an employer, the Marketplace, or Medicare, preventative care is generally covered—including annual wellness appointments and immunizations,” said Dr. Decker. “Many people skip an annual physical because they ‘feel’ healthy, but these appointments can reveal underlying issues that might not yet show symptoms, when they’re easier to treat.”

Key screenings, such as mammograms and colonoscopies, and elective surgeries, such as joint replacements and hysterectomies, may also be less expensive once you've reached your deductible. But, plan early since sometimes these services can be harder to schedule during the second half of the year as more people catch up on their healthcare needs. And, in the case of surgeries, there may be a process that takes time before the procedure can be scheduled.

To check off one or more of these procedures from your to-do list, request an appointment today with your primary care physician. You deserve the best care.

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