Ensure You Get the Most from Your Health Plan  

Every year, Americans are faced with budgeting for expected health care costs. Here’s how to ensure you get the most from your health coverage:

  • Review the explanation of benefits (EOB), which describes the treatments and/or services the insurer paid on your behalf. You can review the EOB online soon after each visit.
  • Know your deductible – the amount you must pay before your plan kicks in. It usually starts on January 1 of each new year. If you’ve selected a large deductible, it may take time to reach that point, but be sure your provider still submits the treatment on your behalf. Mistakes happen, and not applying every visit and treatment toward your deductible can cost you.
  • The out-of-pocket limit caps the amount you pay per calendar year for your share of covered costs. It’s critical your insurer apply all your medical costs, with the exception of uncovered services, to that limit.
  • Your co-pay is the set dollar amount you pay the provider when you receive treatment, such as $25 for your primary care physician (PCP) and $50 for a specialist. To control costs, ensure you see your PCP first unless you need emergency treatment. If possible, visit urgent care centers, which have lower co-pays than ERs.
  • Coinsurance is your share of a covered service and ranges from 70 to 90 percent. The allowed amount is the reduced rate the insurer pays your provider. For example, if the provider bills $800, and the insurer’s agreement allows $170, you owe the percentage of coinsurance on $170, not $800. If your provider is out-of-network, you pay the difference between the allowed amount your insurer pays and the balance. Once you’ve reached your deductible, coinsurance no longer applies; co-pays continue.

Ensure you get the most from your plan by monitoring it regularly. And contact your agent if you have questions.