Mid-Year Check-in: Are You Taking Full Advantage of Your Health Insurance Coverage?
8/27/2024
LAREDO, Texas – 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 urge everyone to fully utilize the preventative care and medical services provided by their health plans," said Jorge Leal, FACHE, chief executive officer of Laredo Medical Center. "If you’re paying towards your premium, it's a ‘use it or lose it’ scenario, so be sure to take advantage of all your benefits before the year concludes and your deductible and out-of-pocket expenses 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.
Dr. D. Tyler King, family medicine provider, highlights another critical aspect of leveraging health insurance benefits: preventative care.
"Regardless of whether your health insurance comes from an employer, the Marketplace, or Medicare, preventative care is typically covered, including annual wellness visits," said Dr. King. "Many people forgo an annual physical because they feel healthy, but these appointments can uncover underlying issues that may not yet have symptoms, making them 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.
Whether you’ve already hit your deductible or you’ve been putting off seeing the doctor, Laredo Medical Center can assist with better understanding and planning for out-of-pocket healthcare costs.
“We’re here to help you make informed healthcare choices,” added Leal. “While it’s not possible to anticipate every aspect of what it takes to restore someone’s health, or what complications could arise from a procedure, our patient access team can provide estimates for what you could expect to pay for care based on your insurance policy and your deductible status.”
To receive an estimate, call (956) 796-2814.
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