9 Things to Use Your Health Insurance For, Now That You’ve Met Your Deductible
Key takeaways:
After you meet your deductible, your health insurance plan helps you pay for covered services, like prescription refills and mental health therapy.
Most health insurance plans cover preventive care services, like mammograms and immunizations, before you meet your deductible.
Check with your insurance provider to learn more about your annual deductible and determine which services your plan covers.
Most health insurance plans cover preventative care services — such as immunizations, mammograms, and colonoscopies — regardless of whether or not you’ve met your annual deductible. However, once you’ve paid your deductible, which depends on your specific plan, your insurance company will help you pay for additional medical services.
For example, if you have a $3,000 deductible, you’ll have to pay the first $3,000 worth of medical expenses before your insurance plan kicks in. After you’ve met your deductible, you will have access to several medical services for a significantly lower out-of-pocket amount, because you will only have to pay copays or coinsurance.
How health insurance works after you meet your deductible
If you’ve met your annual health insurance deductible, you may be wondering, “Now, what?”
After you meet your deductible, your insurance will help you pay for healthcare services that are covered under your plan. But you may have to pay coinsurance or copays, depending on your health plan.
Coinsurance is a percentage of the costs you are responsible for paying out of pocket for services, after you meet your deductible. In this scenario, your insurance company covers the remaining portion of the costs.
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For example, if you have a 20% coinsurance and a medical service costs $2,000, you would be responsible for paying $400. Your insurance company would cover the remaining $1,600.
A copayment is a fixed amount that you pay for medication or specific services before or after you meet your deductible. For instance, you may have a $10 copay for generic medications or a $20 copay for visits with your healthcare provider.
Using Your Health Insurance After You’ve Met Your Deductible
Here are nine ways to take advantage of your healthcare benefits after you meet your deductible and before it resets.
1. Dermatology visits
If you have a family history of skin cancer or something abnormal you want checked, visit a dermatologist after your deductible is met. A once-a-year skin check with a specialist is a way to help prevent melanoma skin cancer.
Note: If you have an immediate concern about your skin,such as a spreading rash or a painful mole, you should see a dermatologist as soon as possible.
2. Elective surgeries
Many people schedule bunion or hammertoe surgeries, meniscus repairs, and frozen shoulder surgeries at the end of the year. This is typically when people have met their deductible and know it’s more likely that their insurance company will help pay for elective surgery.
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Other elective procedures that may be more affordable at the end of the year when you’ve met your deductible include:
Anti-reflux surgery
Joint replacement
Eye surgery
Hernia surgery
Most insurance plans cover elective surgeries that are deemed medically necessary.
3. Imaging, lab work, and diagnostic testing
X-rays, bloodwork, and ultrasounds that are not for preventative care may cost less after you meet your deductible. For example, maybe your healthcare provider wants you to have an ultrasound to check for arthritis or a blood test for iron-deficiency anemia. Waiting till the end of the year might be a good way to save money.
But, again, if you have an immediate need, don’t put off procedures until after you’ve met your deductible.
4. Physical therapy
If you need physical therapy for pain or injury, you may be able to pay less for your visits once your deductible is met. However, this may only be helpful up to a point, because you may have a cap on the number of appointments you’re allowed each year. For example, if you get 30 visits a year and reach your deductible after your 25th appointment, you only have five visits that are eligible for physical therapy benefits left.
5. Injections
If you receive injections such as Prolia (denosumab) for osteoporosis, Medroxyprogesterone (Depo-Provera) for contraception, testosterone, or vitamin B12 — and you’re billed for every injection — meeting your deductible may help lower the costs.
Corticosteroid injections for pain and inflammation and orthobiologic injections that promote healing may also be covered at a reduced rate. However, your healthcare provider may limit you to three or four corticosteroid injections a year.
6. Specialist visits
Has your primary care provider referred you to a cardiologist, gastroenterologist, or endocrinologist for a persistent issue? If you’ve been delaying a visit to a specialist because you were worried about the cost, see if you can get into their office before the end of the year, after you reach your deductible. Specialists can be costly because they typically recommend additional tests and complex procedures to treat a condition.
7. Medical equipment
Do you need a new CPAP machine or a blood sugar monitor? Replacing medical equipment after you meet your annual deductible can save you money. And you can plan ahead for items that regularly need to be upgraded, like knee braces, infusion pumps and supplies, and oxygen equipment and accessories.
8. Prescription medication refills
After you reach your deductible, check to see if you can fill your prescriptions for the rest of the year. You may be able to get a 90-day supply of your medications if your insurance allows it. You’ll save money and be prepared for an emergency or loss of coverage.
9. Mental health therapy
Mental health services are one of the ten essential health benefits that all Affordable Care Act (ACA) plans must cover. Check with your specific health plan to see if your mental health needs are fully or partially covered, as a therapy session can cost anywhere from $65 to over $250 without insurance.
But keep in mind that you may need to get a mental health diagnosis before your plan covers these services.
What services are covered before you meet your deductible?
ACA plans and most other health plans must cover preventive care services at no cost to you. Even if you have not reached your annual deductible, you can typically get access to the following services for free through a provider in your plan’s network:
Blood pressure screening
Depression screening
Diet counseling for high-risk individuals
Immunizations (influenza, hepatitis A, hepatitis B, and more)
Pap smears for women between the ages of 21 and 65
Type 2 diabetes screening for qualified adults between the ages of 40 and 70
Urinary incontinence screening for women
Well-woman visits
The bottom line
Most health insurance plans cover preventive care services like mammograms and pap smears before you meet your deductible. After you reach your deductible, your health insurance will help you pay for covered services, like prescription medications and visits with a specialist.
Review your insurance plan to get a better idea of what services are covered after you meet your deductible. You’ll be able to save more money on medical services if you use your health plan before your deductible resets.
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References
HealthCare.gov. (n.d.). Health benefits and coverage.
