Mid-Year Check-in: Are You Taking Full Advantage of Your Health Insurance Coverage?
8/12/2024
LAS CRUCES, New Mexico – The midpoint of the year 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 preventive care and medical services available through their health plans,” said MountainView CEO Matthew Conrad. “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.
Algele "Cid" Sumulong, M.D., a family medicine provider at MountainView Medical Group - Family Care at Lohman, 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,” Sumulong said. “While we strive to make patients healthier in general, most of medicine is about preservation, where we try to keep what health we've got. Unfortunately, some folks skip routine annual physicals because they ‘feel’ healthy, when in reality, these appointments are critical opportunities to maintain health and pick up on issues before they really become a problem, particularly 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.
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