As the new year kicks off, many of us face the yearly joy of deciphering changes in our health insurance coverage. Whether it’s a plan you picked during open enrollment or one handed to you by your employer, understanding your insurance plan is like reading a map for a treasure hunt—except the treasure is avoiding surprise medical bills.
Contact Keri Lowrey Consulting for help with navigating the world of health insurance.
Here’s how to get through it without pulling your hair out.
1. Review Your Plan Documents
The first step is to crack open that riveting Summary of Benefits and Coverage (SOB). This little masterpiece includes:
Premiums: The monthly fee you’ll lovingly pay whether you use the plan or not.
Deductibles: The amount you’ll shell out before your insurance swoops in to save the day.
Co-pays and Co-insurance: The delightful portion of costs you’re still on the hook for after meeting your deductible.
Out-of-pocket Maximum: The magic number where your plan finally says, “Okay, you’ve paid enough.”
Be sure to check for changes from last year—because nothing says “Happy New Year” like higher co-pays.
2. Understand Your Provider Network
Insurance plans usually come with a “friends list” of preferred doctors, specialists, and hospitals. Sticking to in-network providers typically keeps your costs down. Double-check to see if your favorite healthcare providers are still in-network. If they’re not, you might need to:
Contact your broker
Make new friends (a.k.a. find new providers).
Brace yourself for out-of-network charges that sting worse than a tetanus shot.
Consider other coverage options—if that’s even a thing.
3. Familiarize Yourself with Covered Services
Take a good look at what’s covered in your plan. Preventive services like annual check-ups and screenings are often free, so take advantage of those freebies. Also, keep an eye out for exclusions or “gotcha” rules, like needing prior authorization for certain procedures.
If you need prior authorizations and you're having a difficult time getting them, contact your broker. Having a broker like Keri Lowrey with Keri Lowrey Consulting can save you a lot of headaches and stress, ultimately ending you back at your doctor and saving you money.
4. Learn How to Use Your Benefits
Understanding how to actually use your insurance is half the battle. Look into:
Telehealth Options: Because who doesn’t love a doctor’s appointment from the couch?
Pharmacy Benefits: Make sure your meds are covered, and check which pharmacies won’t charge you a small fortune.
Emergency Care: Know the difference between an “urgent” issue and an “emergency”—your wallet will thank you later.
Contact your broker to help you better understand how to use your benefits
5. Check for Wellness Incentives
Some plans offer wellness perks, like gym discounts or rewards for completing health assessments. If your plan offers these, grab those carrots—you’ve earned them just by navigating this insurance maze.
6. Keep Important Contacts Handy
Save your brokers contact information, the customer service number for your insurance provider and the contact info for your primary care doctor. Trust me, future you will appreciate not having to dig through a mountain of paperwork during a mini crisis.
7. Track Your Expenses
Throughout the year, keep tabs on your medical costs—everything from doctor visits to prescriptions. This can help you:
See how close you are to hitting that deductible (yay?).
Catch billing errors—because mistakes happen.
Plan for future healthcare expenses—or at least brace yourself for them.
Conclusion
Understanding your new insurance plan doesn’t have to feel like solving a Rubik’s Cube in the dark. By taking the time to review the details, staying informed, and using your benefits strategically, you can avoid costly surprises and keep your sanity intact. Here’s to a healthier, less stressful, and more financially secure year ahead—insurance plan and all.
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