Sunday, March 18 , 2018, 3:47 am | Fair 45º

Your Health
A Noozhawk partnership with Cottage Health

How to Get the Most Out of Your Health Insurance Plan

Not that we’re in the new year, it’s important to know the details of your health insurance plan.
Not that we’re in the new year, it’s important to know the details of your health insurance plan. (Cottage Health photo)

Health care coverage seems to be in the news almost every day. Yet many people don’t realize that every medical plan is different, and they are confused when it comes to deductibles, co-pays and out-of-pocket expenses.

Now that it’s a new year, it’s important to keep in mind a few key points so no unexpected medical bills surprise you.

Understand the Total Out-of-Pocket Cost to You

Before any treatment, add in the amount beyond your monthly premiums and verify your deductible, co-pay and co-insurance amounts. Review how much your plan covers for the medical services you need. Also verify your potential maximum out-of-pocket amount, which is the most you would potentially have to pay in any plan year apart from your premium.

Stay in Your Plan’s Network

Health insurance plans usually cover a greater amount when a doctor or hospital is part of the plan’s network. So going outside of network can result in higher out-of-pocket costs. Contact your plan for a list of participating providers.

Does Your Plan Require a Pre-Authorization?

When it comes to elective or nonurgent procedures, verify if your plan requires prior-authorization and that your provider has secured the proper authorization. Otherwise, your plan may refuse to pay some or even any of the services, leaving you with an unexpected bill.

The Deductible on Most Plans Resets by Calendar Year — Every January

Many people are puzzled when they get a medical bill that they thought insurance would cover. For example, say you started a new job with new medical insurance last summer and paid enough out-of-pocket expenses to cover the deductible before the end of the year.

Come January, you need additional medical care and receive a bill that you thought your insurance would cover, but it didn’t. That’s because most insurance plans reset by calendar year, and you must pay your total deductible amount before most coverage begins again.

Keep in mind that some plans have separate deductibles for certain services, like prescription drugs. Also, family plans often have both an individual deductible, which applies to each person, and a family deductible, which applies to all family members.

You May Be Entitled to Some Freebies!

Unlike the deductibles for auto insurance and homeowners insurance, many medical plans cover certain preventative health services at no cost to you, and with some plans there’s no deductible required for these. Check your plan to see what preventative services it covers.

After You Pay Your Deductible, You Usually Only Pay a Co-Payment for Covered Services

However, sometimes with some plans, there can also be a co-insurance amount that will be an additional out-of-pocket expense. Check your plan to know for sure.

Open a Health Savings Account, If Available

Many health plans offer the option for a Health Savings Account, or HSA, which allows you to deposit pretax earnings to spend on health care. Any money and interest earned that isn’t spent that year simply remains in the HSA year after year. Some employers kick in dollars, too, so check with your plan and your employer to see if this is available to you.

  • Ask
  • Vote
  • Investigate
  • Answer

Noozhawk Asks: What’s Your Question?

Welcome to Noozhawk Asks, a new feature in which you ask the questions, you help decide what Noozhawk investigates, and you work with us to find the answers.

Here’s how it works: You share your questions with us in the nearby box. In some cases, we may work with you to find the answers. In others, we may ask you to vote on your top choices to help us narrow the scope. And we’ll be regularly asking you for your feedback on a specific issue or topic.

We also expect to work together with the reader who asked the winning questions to find the answer together. Noozhawk’s objective is to come at questions from a place of curiosity and openness, and we believe a transparent collaboration is the key to achieve it.

The results of our investigation will be published here in this Noozhawk Asks section. Once or twice a month, we plan to do a review of what was asked and answered.

Thanks for asking!

Click here to get started >

Support Noozhawk Today

You are an important ally in our mission to deliver clear, objective, high-quality professional news reporting for Santa Barbara, Goleta and the rest of Santa Barbara County. Join the Hawks Club today to help keep Noozhawk soaring.

We offer four membership levels: $5 a month, $10 a month, $25 a month or $1 a week. Payments can be made through PayPal below, or click here for information on recurring credit-card payments.

Thank you for your vital support.

Reader Comments

Noozhawk is no longer accepting reader comments on our articles. Click here for the announcement. Readers are instead invited to submit letters to the editor by emailing them to [email protected]. Please provide your full name and community, as well as contact information for verification purposes only.


Special Reports

Heroin Rising
<p>Lizette Correa shares a moment with her 9-month-old daughter, Layla, outside their Goleta home. Correa is about to graduate from Project Recovery, a program of the Santa Barbara Council on Alcoholism & Drug Abuse, and is determined to overcome her heroin addiction — for herself and for her daughter. “I look at her and I think ‘I need to be here for her and I need to show her an example, I don’t want her to see me and learn about drugs’,” she says.</p>

In Struggle to Get Clean, and Stay That Way, Young Mother Battles Heroin Addiction

Santa Barbara County sounds alarm as opiate drug use escalates, spreads into mainstream population
Safety Net Series
<p>Charles Condelos, a retired banker, regularly goes to the Santa Barbara Neighborhood Clinics for his primary care and to renew his prescription for back pain medication. He says Dr. Charles Fenzi, who was treating him that day at the Westside Clinic, and Dr. Susan Lawton are some of the best people he’s ever met.</p>

Safety Net: Patchwork of Clinics Struggles to Keep Santa Barbara County Healthy

Clinics that take all comers a lifeline for low-income patients, with new health-care law about to feed even more into overburdened system. First in a series
Prescription for Abuse
<p>American Medical Response emergency medical technicians arrive at Santa Barbara Cottage Hospital with little time to spare for victims of prescription drug overdoses.</p>

Quiet Epidemic of Prescription Drug Abuse Taking a Toll on Santa Barbara County

Evidence of addiction shows an alarming escalation, Noozhawk finds in Prescription for Abuse special report
Mental Health
<p>Rich Detty and his late wife knew something was wrong with their son, Cliff, but were repeatedly stymied in their attempts to get him help from the mental health system. Cliff Detty, 46, died in April while in restraints at Santa Barbara County’s Psychiatric Health Facility.</p>

While Son Struggled with Mental Illness, Father Fought His Own Battle

Cliff Detty's death reveals scope, limitations of seemingly impenetrable mental health system. First in a series