Posted May 22, 2025 by Anupreet Kaur, M.D., FAAFP, Medical Director, Care Management and Population Health
Spring is a season of fresh starts and, of course, catching up on some much-needed spring cleaning. The warmer temperatures and sunshine spring brings are a breath of fresh air after a long winter.
However, spring cleaning shouldn’t be reserved only for your home; your health and health insurance can benefit, too. Organizing your health insurance to maximize coverage ensures your plan is working to help keep you in tip-top shape.
From choosing in-network providers to taking advantage of preventative care and wellness perks to getting strategic about planned procedures, there are many ways to maximize your health insurance — and your pocketbook. That way, when healthcare needs do arise, you’re fully prepared.
Even if you haven’t changed plans and are happy with your current coverage, it’s still a good idea to review your plan benefits every year. Health insurance plans, such as costs, coverage and prescription drug formularies can change annually.
So, during this season of renewal, why not set yourself up for better health?
Before reviewing the 6 tips to maximize your coverage and make the most of your health plan, be sure to check the following:
1. Make sure ALL your providers, including primary care provider, specialists, dentists are “in network”, which means they are covered by your health plan.
Remember, you will end up paying more if a particular provider is not covered by the plan or is “out of network”.
2. Ensure that the healthcare centers and hospitals you visit are all in-network.
3. Next, check your medicines and make sure they are listed on your plan’s drug formulary, therefore, covered.
4. For any planned procedures this year, confirm that they’re covered when performed by your chosen provider and at your preferred facility.
5. Review your deductible and out-of-pocket maximum for the year—these amounts can change annually, even if you stay on the same plan. Once you reach your out-of-pocket maximum, you may be eligible to receive qualifying services at no additional cost.
6. Lastly, familiarize yourself with other costs like copays you’re responsible for at each provider visit, prescription refill and specialist consultation.
Remember, you can contact your plan’s member services at any time if you have questions about any of the above.
Now that you understand your plan for the year, here are a few ways to use it effectively and maximize your benefits.
An easy way to maximize your benefits is choosing providers and facilities that are in-network to save you money when seeking care. This means your insurance company has a contract with certain “in-network” providers, hospitals and pharmacies to provide healthcare drugs and services at a discounted rate to plan members.
For out-of-network services, you’ll typically pay significantly more and, in some cases, could be responsible for the full amount if a plan doesn’t cover out-of-network services.
Contact your health insurance company or check the health plan’s online provider directory to find out which providers and facilities are in-network.
Establish care with a Primary Care Provider if you haven’t already.
Remember, preventive care should be included in most plans, including low coverage and high deductible ones. Catching health issues early when they’re easier to treat can potentially save you money in the long run by reducing the need for expensive treatments later on.
Most policies cover annual checkups and routine screenings for chronic diseases such as cancer, cholesterol and blood pressure, as well as immunizations like the flu or COVID shots at no additional cost.
Your PCP can help you manage your healthcare, keep you healthy by flagging screenings you're eligible for, spot issues before they turn into big concerns and direct you to a specialist if you need one.
While you can’t plan emergency surgeries, you can be strategic about the timing of scheduled testing or procedures around your deductible. Depending on your plan, a deductible can range from a few hundred dollars to a few thousand and starts over the first of every year.
To avoid a considerable upfront cost, you might schedule a big procedure later in the year after you’ve met your deductible. Or, you may want to schedule it right away to meet your deductible early in the year. That way, you’ll have peace of mind knowing medical expenses will be covered for the remainder of the year.
As stated above, for any planned procedures, confirm that it is covered when performed by your chosen provider and at your preferred facility. Don’t assume that all hospitals and facilities charge the same price for a service. You can shop around for the best price. Contact your health insurance company or use your member online portal to find out a fair price in your area for the scheduled appointment.
Prescription drugs can be a large portion of your yearly health expenses. Fortunately, there are ways to manage those costs:
Beyond the basics, review your plan for wellness benefits and other perks that will save you money and help you live a healthier lifestyle. There may be free or discounted benefits you don’t know about and that you may be missing out on, such as: