Make the most of your health benefits

Even after employers pick up a substantial amount of the cost, Americans spend thousands of dollars on health care annually. To help relieve the pain of high health care costs, check out these five ways to maximize your benefits.

1. Stay in your health insurer’s network. If you visit a provider that doesn’t fall within your plan’s network, you’ll pay more for care. If you have a preferred provider organization (PPO) plan, you may receive some level of coverage for out-of-network care. But with a health maintenance organization (HMO) plan, you’ll likely pay the full cost. Use your insurer’s online tools to search for in-network providers.

Starting in 2022, by federal law, insurers must cover at in-network rates “surprise” medical bills, which result when patients unknowingly get care from out-of-network providers in emergencies. You may also get a surprise bill if you visit an in-network facility and see a provider (say, a physician or anesthesiologist) who is not in-network. In the interim, you can appeal with your insurer any surprise bills that you receive. And many states have their own laws that provide some protection against surprise medical bills.

2. Take advantage of preventive-care services. Most health insurance plans must cover certain preventive services without charging you, even if you haven’t met your deductible. They include immunizations; depression and blood-pressure screenings; cholesterol and diabetes screenings for those of specified ages or who have certain risk factors; mammograms for women older than 40; and vision screenings for children. (For a full list, see www. healthcare.gov/coverage/ preventive-care-benefits). High-deductible health plans may cover certain treatments for chronic conditions, such as insulin for diabetes and statins for heart disease, before policyholders reach their deductible.

3. Tune in to telehealth. Consulting with clinicians by phone or video chat has grown by leaps and bounds during the pandemic. If your insurance plan partners with a vendor, such as Teladoc, that specializes in telehealth services, using it may cost you less than seeing your regular doctor, says Anne Brunson of benefits administrator Maestro Health. If you virtually visit one of your usual care providers, you’ll often pay the same amount out of pocket that you would for an in-office appointment, although some insurers may waive or lower your co-payments for telehealth appointments.

4. Schedule appointments after you hit the deductible. If you meet your insurance deductible, squeeze in any appointments that make sense to complete before the plan year closes. Otherwise, you may be on the hook for the full cost when the deductible resets next year.

5. Don’t miss out on employer perks. Your employer may make contributions to your health savings account or flexible spending account on your behalf. Or you may have free access to smoking-cessation or weight-management programs. Participating in such programs may come with incentives, too, such as a reduction in your monthly premium.