Six Expert Tips to Make the Most of Your Health Insurance

In the U.S., health insurance can be perplexing. While many Americans don’t have access to the right health coverage that they could afford, there are hundreds and thousands of people, who don’t have any coverage whatsoever. There are a number of changes that the government still needs to make to ensure that health insurance works for people in a much better way.

However, if you have a health insurance plan within the current system, you can use your insurance mindfully to prepare yourself for better coverage and lower out-of-pocket expenses.

Here’s how you can make the most of your health insurance:

#1 Go Through Your Health Plan’s Coverage Documents, Each Year

Before you determine how to use your health plan, it is important to know what it contains. Many enrollees fail to take full advantage of the benefits offered by their health insurance in Texas, just because they are not aware of such benefits. In worst cases, some even end up paying out-of-pocket for the services that might be covered in their plans.

Health insurers in the U.S. provide, in writing, a synopsis of coverage and benefits in an easy-to-understand language. If you have not received the same in your inbox at the start of the year, you should log on to your health insurer’s website or call your insurer to ask for it.

At the beginning of every year, take out some time to look through your private health insurance plan’s summary of benefits, even if you choose to continue the same plan and you are quite sure about what the documents contain.

Many a time, insurers make modifications to benefits that become effective upon policy renewal. Hence, you should review those changes while ensuring that you understand what they are and how they might affect you.

Additionally, it is important to examine your benefits if your health status has changed lately. Some facets of your private health insurance that were not important to your earlier, might now be worth looking at, such as coverage for prenatal benefits and visits to specialists.


#2 Search for a Great Primary Care Physician

The extent to which you use your insurance largely depends on your health status. A yearly physical exam at your primary care physician’s office can help you stay updated on your health, which will give you a picture of the types of health care services you might need in the future.

It is important to a doctor who personally knows you or who has been examining you for many years. In the absence of a primary care physician, you randomly visit different doctors when you are not well. These doctors may not know what to consider normal in your case with respect to lab tests and vital signs, so they often react at that moment.

A good doctor is one who is well aware of your family medical history as well as your normal symptoms and vital signs. They may ensure your good health by suggesting tests you are eligible for, detecting minor problems early on before they turn into larger issues, and referring you to a specialist if needed.

If you don’t have a primary care doctor, consider getting referrals from your relatives and friends as well as other people in your network, instead of solely banking on online reviews.

There’s nothing more effective than talking to a colleague, a friend, or a neighbor, and asking them if they have a good primary care physician and what they like (or don’t like) about them.


#3 Take Advantage of Preventive Care

Even if you have a basic, high-deductible health insurance plan, it should include screenings or “preventive” care you may need. Simply put, with your plan, you shouldn’t be responsible for any copays or other out-of-pocket expenses. This may include screenings for blood pressure, diabetes, and cholesterol. Generally, breast cancer screening is free and so is immunization, such as a flu vaccine.

The American Academy of Family Physicians regularly updates a cheat sheet, mentioning recommended screenings with respect to age. However, your physician may suggest something different, based on your family history, personal health status, and risk factors.


#4 Plan the Timing of Procedures Strategically

While you can’t plan emergency surgery like appendectomy, you may be a little strategic while timing your planned procedures and appointments.

Health plans, including Medigap policies in Texas, feature a deductible, which is the payment threshold an enrollee has to meet before their insurance starts covering their medical expenses fully. Depending on the plan you choose, your yearly deductible may vary from several hundred dollars to a few thousand dollars.

Every year, on January 1, the deductible resets to zero. This means you will again need to pay for health services out-of-pocket till you meet your deductible.

If there is a costly medical procedure that you may plan in advance, there are several ways to schedule it, in order to maximize your coverage. Some individuals may choose to wait to get an expensive procedure until they reach their yearly deductible. This makes sense if an individual doesn’t have a lot of savings. If a person pays into their deductible for the services they receive over the course of a given enrollment year and then plans a surgery after meeting their deductible for that year, it is highly likely that their plan will cover the bulk of the cost for the major procedure and they might not require paying a huge out-of-pocket bill.

Other people, who have enough savings, may schedule a costlier procedure to meet their yearly deductible early. This way, they can have the peace of mind that the remaining costs of services in that year will be covered by their policy.


#5 Know How to File a Health Insurance Claim

If you visit a doctor’s office or a clinic that doesn’t pay your insurer, you may have to bear the entire cost on your own initially and file a claim later on, so that your insurer pays you back, at least some part of it, if not all.

When you pay out-of-pocket, you should ask your health provider for an itemized receipt to be used to file a claim with your health insurer. Before leaving the health care facility, ask them to get you a printout of the same, containing necessary information like the diagnosis code and date of service, etc.

You will then require a claims form. If you are unsure which form is right, consider calling your insurance company to ask for the appropriate claims form. Once you have the right form, fill in all the details, except your sign and date fields. Then, scan or take multiple copies of it. Thereafter, whenever you require filing a claim, you just have to sign it, mention the date, and attached it to the mail, along with the itemized receipt from your doctor’s office.

In some states, once your health insurance company receives your claim, they need to process it, and pay you or your provider within a specific time frame; e.g., 30 days. You can find information regarding “prompt pay” laws on your state’s insurance department website.


#6 Do Not Ignore Additional Benefits

People struggle so much, only to know and understand basic health coverage or a Medicare Supplement plan in Texas. Having said that, despite all the logistical and fiscal challenges that creep in while you navigate health insurance, your plan might include some attractive benefits.

Are you looking for Zumba classes? Your health plan might be offering some discounts on your local gym membership. Some health plans also provide great discounts on services, focused on improving quality of life, such as massages or LASIK surgery. You may also be able to save dollars on prescription medications by using your insurance company’s preferred pharmacies, or by visiting your insurance company’s website to look for different health facilities and providers for the kind of care you need.



If thinking about health insurance makes you anxious, know that you are not alone. It is important to understand that a health plan is an option to maximize your health, which you can do by knowing how to utilize it optimally. For this, you would need to dedicate time to exploring and researching to clearly understand your plan and the benefits it offers.

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