Health insurance is one of the most important tools for protecting both your health and your family’s finances. Because medical care in the United States can be very expensive, even people who have insurance may still have to pay thousands of dollars out of pocket in some situations. For that reason, many health insurance plans today do more than help pay for treatment when you are sick. They also encourage members to take care of their health proactively through preventive care and routine wellness services.
In practice, however, many of these benefits go unused. Most people only use their insurance when they are sick or facing an urgent situation, while missing out on services such as free annual checkups, mental health support, and other wellness programs.
In this article, I will introduce several common benefits that many U.S. health insurance plans may cover but that people often overlook.
Free annual checkups and preventive care
Most health insurance plans cover 100% of the cost of preventive care, including annual checkups, vaccinations such as flu shots or COVID vaccines, and screening tests recommended by your doctor.
You usually do not need to pay a copay as long as you use an in-network doctor, clinic, or hospital.
Prescription drugs
Insurance plans usually have a list of covered medications, often called a formulary. In many cases, you only need to pay a portion of the cost, such as a small copay of about $5 to $30. When you see a doctor, you can ask whether the medication being prescribed is covered by your insurance plan, unless there is a special medical reason to use a different option.
Telehealth
Telehealth allows you to receive medical care through online or virtual appointments. For many routine health concerns, telehealth can be a convenient alternative to an in-person visit. This option can save time and may also reduce costs compared with in-person visits, depending on your plan.
Mental health care
Mental health is receiving more attention today than ever before. Many insurance plans include coverage for mental health services such as therapy, counseling, and telehealth appointments. If you are an international student or a newcomer to the United States, these services can be helpful for managing stress, anxiety, loneliness, or the sense of being overwhelmed in a new environment.
Maternity benefits
If you are planning to have a child, you should also learn about the maternity benefits included in your insurance plan. Many plans may cover all or part of services such as in vitro fertilization (IVF), prenatal care, childbirth, breastfeeding support, breast pumps, and postpartum care.
Additional wellness programs
Some insurance plans also offer wellness benefits such as discounts for gym or yoga memberships, or free access to health, fitness, or meditation apps. These programs can be very practical, but many people do not know they are available.
Urgent care and emergency room care
Most health insurance plans provide some coverage for emergency care. However, the amount covered, as well as your deductible, copay, or coinsurance, can vary greatly from one plan to another.
Many people go to the emergency room when an urgent care center would have been enough, which can result in much higher medical bills. If the situation is not a true emergency, it is a good idea to check your benefits before choosing where to go for care.
Basic insurance terms to understand
There are four basic terms you should understand when comparing how different insurance plans pay for care:
· Premium: the monthly amount you pay for health insurance.
· Deductible: the amount you must pay out of pocket before the insurance company begins sharing costs. For example, if your deductible is $2,000, you must pay the first $2,000 for eligible services before insurance starts helping.
· Copay: the fixed amount you pay each time you use a service. For example, a primary care visit may cost $25, while a specialist visit may cost $50. The remaining amount is paid by insurance according to your plan.
· Coinsurance: after you meet your deductible, you and the insurance company share the cost. A common example is an 80/20 split, where the insurance company pays 80% and you pay 20%.
· Out-of-pocket maximum: the most you will have to pay in a year for covered healthcare expenses. After you reach this limit, the insurance company usually pays nearly all covered medical costs for the rest of the year.
Conclusion
Health insurance in the United States is a tool that helps you take care of your health and protects you from major financial shocks caused by illness or medical emergencies.
If you are new to the U.S. healthcare system and still learning how insurance works, here are a few simple principles that can help you make better use of your benefits:
Maintain health insurance coverage whenever possible.
Read your benefits and payment rules carefully before choosing a plan.
Take advantage of free preventive services.
Check whether the doctors and hospitals you need are in-network.
Always ask medical staff about estimated costs before receiving care.
Understand how your deductible, copay, coinsurance, and out-of-pocket maximum work.
Keep all bills and insurance-related documents.
Do not hesitate to call your insurance company when something is unclear.