You have a health plan and a brand new membership card…now what?
If your health coverage is through your employer or an individual plan that you purchased on your own, these tips will help you put your benefits to better use and take advantage of services your plan might offer.
1. Know These Terms
Using your health benefits effectively starts with knowing how much your care might cost. Knowing these common health care terms can help you make sense of the statements your plan sends you from time to time, and these terms will also help you grasp what your overall financial responsibility might be for a single year.
Deductible: The amount your plan requires you to pay toward your health care each year before your health plan begins to pay. So let’s say your plan has a $1,000 deductible. This means you’ll be responsible for the first $1,000 of costs for your health care this year before your health plan begins to pay.
Coinsurance/Copay: Plans often require you to share in the cost of your care even after the deductible is met. A copayment is a fixed payment (for example, $20 per doctor’s visit) toward the cost of your care, and coinsurance is a certain percentage of the cost of health care services that you receive. If your plan has a 20 percent coinsurance for certain services, that means the plan will pay for 80 percent, and you’ll be responsible for paying the remaining 20 percent.
Out-of-Pocket Maximum: Most health plans limit the amount of money you’re responsible for paying during a single year by putting a cap on your out-of-pocket expenses. So, if you are seriously injured or ill, you may only be responsible for a certain amount before your health plan takes over.
Only 7 percent of Americans could successfully define all four of these terms, according to a recent UnitedHealthcare Consumer Sentiment Survey.
2. Know Your Network
In the health care world, a “network” is a group of doctors, other health care professionals, hospitals, facilities, and suppliers with which your health plan has contracted to provide you with health care services.
Many health plans distinguish between “in-network” and “out-of-network” health professionals and facilities. You may incur higher out-of-pocket costs if you seek treatment outside the network.
This is why it’s so important to make sure a doctor is in your network before scheduling an appointment. And before a medical procedure such as a surgery, make sure that both the doctor and the facility in which he or she practices are in your network.
3. Fire Up the Calculator
You wouldn’t want to buy a new television without shopping around for the best price, right? Well, it pays to do the same thing before you see a doctor.
Using UnitedHealthcare’s online and mobile resources available on myuhc.com® and via the UnitedHealthcare Health4Me app, people can enter a health condition or treatment, such as “back pain” or “chest X-ray,” to see what health care providers in your area typically charge. Then, for UnitedHealthcare plan participants, narrow your search by entering specific care providers or facilities you’re considering. You can obtain estimates for both total costs and out-of-pocket costs for individual physicians and compare cost efficiency among different health care providers. Guroo.com is another source for information on health care costs and where to get quality care.
4. A PSA about your HSA
If you have a high-deductible plan, you may be entitled to open a health savings account, or HSA. How do you know if you have such a plan? If you have an individual plan (meaning you are the only one covered), and your deductible is at least $1,300 and your out-of-pocket expenses are capped at $6,550, you’ve got a high-deductible plan. This is also the case if you have a family plan with a deductible of at least $2,600 and out-of-pocket costs capped at no more than $13,100.
Why are HSAs worth knowing about? You can deposit money into the HSA before you pay any payroll taxes on it, provided your employer offers this arrangement. You can then use that money to pay for out-of-pocket costs for a qualified medical expense, without triggering any tax penalties. Just consider all of the medical expenses that either aren’t covered by your plan or aren’t fully covered – things like medically necessary acupuncture, contact lenses, dental treatments, copays, hearing aids, fertility treatment, laser eye surgery, tobacco cessation programs, obesity weight loss programs, and much more. If you add up what you spend on these services throughout the year, it’s often not a trivial amount. Paying for these services with an HSA can be a cost-effective way to cover your health care needs while getting tax benefits at the same time.