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How to Maximize Health Insurance Benefits and Save on Medical Bills

Most health insurance plans have out-of-pocket expenses in forms of copays, deductible and co-insurance. The following tips could save you a significant amount on medical bills:

  1. Verify with your medical providers if they are in-network for your health insurance plan, by presenting your ID card. The insurance companies cannot force negotiated prices on out-of-network providers, as they do for their in-network providers. If the provider is out of network, you may end up paying significantly more. The difference could be in the thousands.
  2. Medical in-network providers include: doctors, dentists, labs, imaging centers     (X-ray, MRI, ultrasound), hospitals, pharmacies, chiropractors, physical therapists and other medical providers.
  3. At many doctors' offices, the lab work is administered by another provider like Quest Diagnostics and others. Make sure to use in-network lab providers to secure coverage, and avoid high medical bills.
  4. Most HMO plans do not have out of network coverage, except for true emergencies. Any services performed out of network are 100% your responsibility to pay. Many HMO plans require referrals from a Primary Care Physician to see other medical providers and secure the coverage.
  5. When prescribed an Rx, check with your doctor or at your pharmacy for a generic alternative medication. It has the same medical treatment, is approved by the FDA and costs significantly less.
  6. It is highly recommended to register online on the insurance’s web page. You will be able to find doctors and providers in-network, estimate the cost of some treatments in advance, and review the Explanation of Benefits (EOB) bills from the medical providers.
  7. Review your benefits in details on the plan's SBC (Summary Of Benefits) document. The SBC details what you are expected to pay for a primary doctor visit, a specialist visit, Rx, Lab, a procedure, emergency room visit, urgent-care, hospital stay and other services.
  8. For scheduled procedures, it is recommended to get pre-authorization and an estimate of the cost from the insurance carrier, to secure the coverage. Insurance companies approve only necessity medical procedures.
  9. Always check your medical bill statement thoroughly. Each item on the invoice may include your cost share (deductible, co-insurance, copays). Make sure that you understand every detail and charge in the bill, so there are no mistakes. Medical providers use billing agencies in order to maximize their income, which may increase your balance in the end.
  10. You may be eligible for a subsidy on your family's health insurance from your state. Possible subsidies: tax credit, cost sharing, Medicaid /CHIP and other aid programs under the Obamacare - Affordable Care Act. Only applications through your state's health insurance marketplace (like Healthcare.gov, Covered California, MD Health Connection) will be considered for subsidies. 
  11. When traveling outside of the USA, only true emergencies may be covered by your domestic health insurance. In case of a claim overseas you will have to you pay the full amount for the service first, and file a claim later. Some countries will not let you leave before paying the entire balance. Domestic health insurance carriers do not have in-network providers outside of the USA. Consider to purchase Travel Insurance for trips outside of the USA. Travel insurances cover many medical services not just emergencies overseas. Some travel insurance plans have in-network providers overseas, preventing you from paying the full balance upfront.
  12. Original Medicare and Medicaid do not have any coverage outside of the USA, even not for emergencies. Medicare and Medicaid members (adults and children) should purchase travel insurance for the time they travel out of the country, even for a short time.
  13. The Original Medicare Health insurance is limited in coverage and does not include insurance for prescription drugs. It is recommended to purchase Medicare supplement or Medicare advantage insurance plans and a Medicare Rx plan, to significantly increase the coverage and save on medical expenses.
  14. It is important to check eligibility for Medicare when turning 65, even if you are still covered under a group policy.  Enrollment late to Medicare may lead to increased premiums as a penalty for long time.
  15. US citizens and Green Card holders age 65+ who are not eligible for Medicare insurance may be eligible for other health insurance coverage, most likely with coverage limitations. Due to the limitation in coverage, it is recommended to check with an insurance broker on the coverage details.
  16. At the time of the annual renewal it is very important to review your Medicare, Medicaid or Health insurance coverage in thoroughly. The insurance companies are changing the terms and the coverage each year. It is also an opportunity for the family to review their medical and Rx medication coverage, and apply for the best possible plan moving forward.
  17. Many health insurance, Medicare and Medicaid plans are cancelled due to nonpayment of the premium. In most cases the nonpayment is due to change of a credit card, change of bank account, relocation to another address, or due to statement lost in the mail. It is the consumer's responsibility to pay the premium on time. Once the insurance is cancelled due to nonpayment, the family has to wait until the next open enrollment to re-apply. During that time the family may have to pay for medical treatment and medications at full price, without any insurance coverage.
  18. Consider to own Long Term Care (LTC) insurance. Medicare and ACA health insurance plans have limitations on coverage, when medical treatment does not improve the patient's condition.
  19. Consider to own Life insurance with Living benefits, or Critical Illness insurance. Both insurances pay benefits if the owner has been diagnosed with a major illness like Cancer, heart attack or had a stroke.

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