It’s time to deal with your favorite to-do list item (not). Health insurance.
Do we have to?
Yes. Because you’re probably nearing the end of your benefit year. And that means you could stand to save some money if you schedule wisely.
OK, I’m listening.
For most people with health insurance, your plan starts over on Jan. 1. That means certain benefits expire on Dec. 31. So you should pay close attention to…
Annual check-ups…Insurance typically covers one physical, a flu shot, vaccinations, and preventative exams like a pap smear annually. But if you snooze, you lose those health care visits. Read more about what doc appointments you should schedule (and when) here.
Your deductible...This is the amount you have to pay before insurance kicks in. (Note: usually the lower your insurance premium — aka your monthly payment — the higher this number is.) After you hit your deductible, insurance covers a portion of your expenses before you reach another limit: your out-of-pocket max (then it pays for everything that’s covered afterward). These amounts reset every year. So if you’re close to hitting your deductible, be strategic about the...
Timing of your procedures...To be clear: You shouldn’t avoid medical services you need until you meet your deductible. But if you do hit it, you can look at that as a green light to book all of the things you otherwise wouldn’t have scheduled because of the price tag. For example: booking an MRI for peace of mind or planning ACL surgery that isn’t urgent. Because instead of paying hundreds or thousands a pop, you’ll probably only have to cough up a copay (a set amount for a service) or coinsurance (a percentage of the bill) for specialists, tests, and medication. Head spinning? Check out our health insurance term glossary.
Your HSA contributions...If you invest in a health savings account (that’s HSA for short), that means you’re holding onto pre-tax money for future medical expenses. Your move: If you can afford to increase your HSA contributions before the year’s up, it could save you cash in the future. Because they roll over to the next year. Bonus: Some employers match your HSA contributions. Which means mo’ money, mo’ pre-tax savings.
Your FSA...This is a flexible spending account. Like an HSA, it uses pre-tax dollars. Unlike an HSA, it typically does expire at the end of the year. So make sure you use it up before Dec. 31 on anything from glasses and COVID tests, to tampons or something else from this list. PSA: Your company might offer a grace period for leftover cash, or the ability to carry over $500. Or neither. Would be wise to find out.
TBH I don’t know if I’m taking advantage of my benefits.
We’ve got you covered, and your insurance co might, too. Look into...
Therapy...The law requires that most insurance plans treat mental health like physical coverage. And if you’re dealing with burnout, anxiety, or depression, it might be time to talk to someone. Finding the right provider, who also takes your insurance, can be tough. But we got you.
Dietitians...Your insurance might pay for a visit to a dietitian, nutritionist, or another specialist. Particularly if it’s considered a preventative service, your PCP refers you, or if you have a specific health condition like diabetes. Why you might want to get nutrition help: An RDN can help you sort out digestive issues, make sure you're getting the right nutrients (particularly if you’re pregnant or a new parent), or just share practical nutrition advice.
Fertility treatment or adoption...Coverage differs by state and plan. But a number of states require insurance providers to pay for fertility testing. Some plans might also offer partial coverage of procedures like egg freezing and IVF. And there’s a small percentage of employer programs that offer adoption assistance.
Exercise stipends...Get your Peloton receipts ready. A number of plans offer subsidized gym memberships or reimbursement for fitness classes or equipment. Now, if we could just get paid for all the times we planned to exercise.
So I’m all set?
Not quite. Open enrollment is here. If you want to weigh your options, we have tips for picking the right employer-backed plan here, and shopping the gov marketplace here. Definitely consider Medicaid if you qualify for it. And if there’s a certain kind of medication or surgery you know you’ll need next year, make sure your existing plan covers it.
Health insurance can get complicated. But this much is clear: You have the right to alllll your coverage before the year’s up. Make sure you’re taking advantage of your plan by reading the fine print, or phoning a customer service rep or expert who can break it down for you. You paid for insurance, so don’t leave money on the table.
theSkimm consulted with patient advocate Michelle Riddle for this guide.
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