CVC Director of Patient Services Lauren Ruiz offers tips for getting the most out of your health insurance plan in 2019—and minimizing costs to you.
Open enrollment periods for both Medicare and Marketplace insurance receive a lot of attention toward each year’s end. Millions of dollars are spent on advertising and outreach and a variety of insurance assisters are available to help with the enrollment process.
Once the hubbub of enrollment activities settles down, people tend to assume consumers are all set to go for the year. As a certified application counselor for Caring Voice Coalition, I have enrolled and answered insurance questions for thousands of individuals over the years. In my experience, I receive just as many questions after enrollment as I do during the plan selection process.
To address some of those, we’ve collected three things you can do now before you go into a new year to save you money and heartache.
1. Take advantage of what you can get for free.
Your insurance plan has an invested interest in keeping you healthy and avoiding major costs down the line, so many preventive care services are available at no cost to you even before you have met your deductible (if your plan has one). Many services aimed at slowing down an illness you already have fall in this category too.
Preventive care can include various screenings and tests, shots and immunizations, and even certain types of counseling. Some of the most common services include:
Screenings and tests:
- Cardiovascular disease screening
- Depression screening
- Diabetes screening
- Hepatitis B and C screenings
- Glaucoma tests
- Cancer screenings for colorectal, lung, breast, and prostate cancer
Shots and immunizations:
Coverage varies depending on your insurance plan. You can see a more thorough list here.
- Medicare covers shots for: Flu, hepatitis B and pneumonia.
- Medicaid covers all recommended vaccines for children.
- Private health insurance typically covers recommended vaccinations.
- Alcohol misuse counseling
- Diabetes self-management training
- Obesity counseling
- Tobacco use cessation counseling
A few things to know before you seek out preventive care:
- Find a care provider in your insurance plan’s provider network to ensure the preventative care is covered.
- Preventative service coverage can vary depending on your age or health history. Talk to your doctor each year about the preventive care you should receive.
A complete list of preventive services covered by Medicare Part B can be found here and one for services covered by private insurance plans that comply with the Affordable Care Act (ACA) can be found here. (Note: ACA-compliant plans offer additional preventive services for women and children.)
Supplemental health benefits are benefits that are considered extra because, unlike preventive health benefits and essential health benefits, they are not required by law. They may include things like:
- Discounted gym memberships
- In-home personal assistance
- Respite services for caregivers
- Adult daycare
- Non-medical transportation
Check the booklet you receive from your plan to see if they offer any additional benefits or contact them directly to ask. These benefits are not always made obvious but taking advantage of them is a great way to truly get the most out of your health insurance.
2. Know what to do if your provider networks change.
Figuring out who is in network for your health insurance plan can seriously impact how much you end up paying. Confirm that any doctors you want to keep seeing are in network before signing up.
Of course, midyear changes to provider networks can happen.
Below are three types of laws that can protect you if you are experiencing this kind of network change. Contact your insurance plan or health care provider to find out if any of these apply to your situation.
- You may have out-of-network rights if your health plan does not have in-network providers sufficient to meet your medical needs in a reasonable and timely manner, you may have the option to receive care from an out-of-network doctor.
- Continuity of care protections exist in some states. They allow you to temporarily continue seeing your health care providers and to pay in-network costs if they leave your plan’s network midyear. View this map to see the continuity of care protections for each state, so that you are prepared to talk to your doctor or insurance provider if you encounter issues with your network.
- If you are enrolled in a Medicare Advantage plan and your plan terminates its contract with a provider group or medical facility midyear, the Centers for Medicare and Medicaid Services (CMS) may determine you have the right to change your plan outside of the normal open enrollment period. If CMS makes this determination your plan must notify you at least 30 days in advance of the network changes. You then have a 90-day “special enrollment” opportunity after the network changes take effect to either switch back to Original Medicare or select a different Medicare Advantage plan.
3. Learn all about your local urgent care centers—especially which are covered by your insurance plan.
Urgent care clinics are expanding everywhere and are a more convenient and much cheaper option than the emergency room. Your insurance will only cover care received at urgent clinics in their networks, so check that yours is in network before visiting.
Typically if you are seeking urgent care you may not be in a position to contact your insurance plan to confirm which urgent care centers are considered in-network. At the beginning of the year you should check your plan’s “Summary of Benefits and Coverage” document or call them directly and find out which urgent care centers are in-network. This may help you avoid large bills later on.
If you experience a life- or limb-threatening emergency, you should seek care from an emergency room at the nearest in-network hospital.
For more help navigating your health insurance in 2019, don’t hesitate to call Caring Voice Coalition at (888) 267-1440.