Navigating the world of health insurance can be overwhelming, but if you’ve purchased a plan on the Affordable Care Act exchange, you’re already on the right track to ensuring comprehensive health coverage.
You can get the most out of your plan and save money by understanding your benefits, costs and the tools available to you. Here’s what you need to know to ensure you take full advantage of your plan’s offerings and minimize needless outlays.
Take advantage of preventive care services
Most plans cover preventive services at no cost to you as long as you see an in-network provider. Covered preventive services include:
- Routine vaccinations (e.g., flu shots, COVID-19 vaccines and others recommended by the Centers for Disease Control and Prevention).
- Cancer screenings (e.g., mammograms, colonoscopies).
- Annual wellness exams.
- Screenings for conditions like high blood pressure, diabetes and cholesterol.
- Birth control and family planning services.
You benefit by taking advantage of these free services as they can detect potential health issues early and help you maintain better overall health.
Understand your plan’s cost-sharing structure
The higher your premium the lower your out-of-pocket costs when you seek medical services. Conversely, lower-premium plans come with higher out-of-pocket costs. These include:
- Deductible: The amount you pay out of pocket before your insurance starts to cover certain services.
- Copay: A fixed amount you pay for specific services, such as $25 for a primary care visit.
- Coinsurance: The percentage of costs you pay for covered services after meeting your deductible (e.g., 20% of a hospital bill).
- Out-of-pocket maximum: The most you’ll pay in a year for covered services. After you hit this limit, your insurer covers 100% of costs for the remainder of the year.
Understanding these terms can help you budget for medical expenses and decide when to seek care.
Utilize a health savings account, if eligible
If your plan is a high-deductible health plan, you may be eligible to open an HSA, which allows you to:
- Save pre-tax dollars to pay for qualified medical expenses (e.g., doctor visits, prescriptions, and even some over-the-counter items).
- Roll over unused funds year to year — they never expire.
- Earn interest or investment returns on your savings.
Using an HSA can reduce your taxable income while giving you a financial cushion for health care costs.
Stay in-network
ACA plans typically have a network of preferred providers. To minimize out-of-pocket costs, always try to see in-network doctors, hospitals and specialists. Out-of-network care often comes with much higher costs, and in some cases, may not be covered at all.
Use telehealth services
Many ACA plans now include telehealth benefits. Virtual visits with doctors can save you time and money, especially for minor illnesses or follow-up appointments.
Check your plan’s policy on telehealth to see if it’s included at a discount.
Advocate for your care
Finally, don’t hesitate to ask your insurer questions about your coverage, appeal denied claims or negotiate bills. Insurance can be complex, but resources like your plan’s customer service, or your insurance navigator — an individual, typically an insurance agent — can help you select coverage.
By understanding your plan’s benefits and costs, taking advantage of free preventive services, and making the most of available tools like HSAs and telemedicine, you can take full advantage of your ACA health insurance and prioritize your well-being.
