How to use your health insurance benefits

Whether you’re spending time with friends and family, feeling the stress of the holidays or closing out the year on a quieter note, your health insurance may be the furthest thing on your mind. But, since many health plans reset on January 1, you may want to consider what unused benefits are left.

Reviewing your health plan can help you understand your coverage and plan for any care your doctor has recommended. If your plan follows the calendar year, the months and weeks leading up to December 31 can be prime time to use those benefits you earned by scheduling appointments your doctor has already recommended.

Not sure what care you may need? You’re not alone. A great place to start is by reviewing your health plan and thinking about any preventive care, screenings or follow-up appointments your doctor has recommended, says Dr. Mohamad Fakih, Chief Quality Officer at Ascension. Here, he answers common questions about health benefits to help you stay on top of your care.

Why schedule healthcare appointments before December 31?

Many health insurance plans operate on a calendar-year basis, which means your plan may reset at the beginning of a new year.

If you’ve already met or are close to meeting your deductible or out-of-pocket maximum, getting care before the end of your plan year may affect what you pay. Check with your insurance provider to understand your specific coverage, costs and plan-year dates.

End-of-year appointment availability may become more limited as more people try to squeeze in care before the holidays and the start of a new year, so one tip Dr. Fakih shares is to schedule any appointments as early as possible.

What health benefits should you use before the end of the year?

Knowing what benefits you should use depends on your health insurance plan. “Your needs will depend on your age, health history, doctor’s recommendations and coverage,” says Dr. Fakih. 

To maximize your coverage, talk to your primary care doctor or specialists to see if you’re due for any of the following:

• Annual wellness or preventive visits
• Follow-up appointments
• Routine health screenings
• Lab tests or diagnostic imaging
• Vaccinations

If you’ve already met your deductible for the year, this can be a good time to talk to a doctor to schedule any outstanding screenings, imaging or testing you may need. Doing so ensures your insurance company shares the cost before your deductible reset on January 1. 

How can you check your remaining health insurance benefits?

Contacting your insurance provider is the best way to help you understand your benefits and what may be remaining before the year is over. When talking to your insurance provider or looking up your plan online, learning the answers to the following questions help you understand your benefits:

• When does my health insurance plan end?
• Have I met my deductible?
• How close am I to my out-of-pocket maximum?
• Which preventive services are covered?
• Do I need a referral or prior authorization?
• Are the doctor, facility and services I’m considering in-network?

You will be able to make a better decision about what care you need and avoid unexpected costs.

Why should you schedule care now?

Dr. Fakih stresses that you should never delay care if your provider has recommended tests or treatments. There is no better time like the present to check on your health before entering a new year. And if you’re experiencing new symptoms that weren’t present during your last appointment, now is the time to get the answers you may need to help find relief.

Make your health a priority year round

If you’ve been meaning to schedule an annual visit, complete preventative care or screening, or follow up with your doctor, consider making that appointment sooner than later. “Always being proactive for your health is a wonderful goal to have,” says Dr. Fakih. 

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