Having health insurance is important—but knowing how to actually use your plan can save you money and improve your health. Many people pay monthly premiums but don’t fully understand what their coverage offers. By learning to take advantage of your benefits, you can maximize your plan’s value, avoid unexpected bills, and make smarter healthcare choices.
Let’s explore practical ways to get the most out of your health insurance coverage.
Know What Your Plan Covers (and What It Doesn’t)
It may sound basic, but step one is to thoroughly review your plan documents—especially the Summary of Benefits and Coverage (SBC) and Evidence of Coverage (EOC). These documents explain:
Covered services (doctor visits, lab work, prescriptions, mental health, preventive care, etc.)
Coverage limitations or exclusions
Costs: deductibles, copays, coinsurance, and out-of-pocket maximums
In-network vs. out-of-network coverage
Understanding what your plan covers prevents surprise bills and ensures you take advantage of all available benefits.
Prioritize Preventive Care
Many health plans cover preventive services at no cost to you (meaning no copay or deductible). These services are key to staying healthy and catching issues early.
Examples of covered preventive care:
Annual physical exams
Immunizations (flu shot, COVID-19 vaccine, Tdap, etc.)
Screenings (blood pressure, cholesterol, diabetes)
Cancer screenings (mammograms, colonoscopies, Pap smears)
Mental health screenings
Pediatric well-child visits
Make it a habit to schedule these services each year. They’re covered because they work—use them!
Choose In-Network Providers
Using in-network providers is one of the easiest ways to save money. In-network doctors, specialists, labs, and hospitals have contracted rates with your insurance company, which means lower out-of-pocket costs for you.
Before seeing a provider, always check:
If they are in your plan’s network (your insurer’s website has a directory)
If referrals are required (for HMO plans)
If prior authorization is needed for certain services
Going out of network can result in much higher costs—or no coverage at all.
Understand and Manage Your Deductible
Your deductible is the amount you must pay out-of-pocket each year before your insurance starts covering more of your care.
Here’s how it typically works:
| Example Plan | Annual Deductible | Coinsurance After Deductible | Out-of-Pocket Maximum |
|---|---|---|---|
| Plan A | $2,000 | 20% | $6,000 |
Once you meet the $2,000 deductible, you only pay 20% of covered services.
After spending $6,000 total out-of-pocket, your insurance covers 100% of remaining covered costs for the year.
Understanding where you are in meeting your deductible helps you plan for medical expenses throughout the year.
Use Telemedicine Services When Appropriate
Many plans now include telemedicine (virtual doctor visits), often with lower copays than in-person visits.
Telemedicine is great for:
Minor illnesses (cold, flu, allergies)
Medication refills
Behavioral health therapy
Chronic condition check-ins
It’s convenient, saves time, and reduces healthcare costs.
Take Advantage of Prescription Benefits
If your plan includes prescription drug coverage, there are ways to save:
Ask your doctor about generic alternatives.
Use your plan’s preferred mail-order pharmacy for maintenance medications.
Check for drug discount programs or manufacturer coupons.
Also, review your plan’s formulary (list of covered medications) to avoid surprises at the pharmacy.
Maximize Your HSA or FSA (If Available)
If you have access to a Health Savings Account (HSA) or Flexible Spending Account (FSA), use them wisely. These accounts let you pay for qualified medical expenses with pre-tax dollars, which lowers your taxable income.
Common eligible expenses:
Copays and coinsurance
Prescription medications
Dental and vision care
Medical devices and supplies
HSAs also roll over year to year and can grow tax-free.
| Feature | HSA | FSA |
|---|---|---|
| Who can have one? | Those with a high-deductible plan | Offered by many employer plans |
| Rollover? | Yes, funds stay with you | “Use it or lose it” each year (some allow small rollover) |
| Tax advantages? | Yes: tax-deductible contributions, tax-free growth, tax-free withdrawals | Yes: contributions are pre-tax |
Use Care Navigation and Case Management Services
Many insurers offer care management or health coaching for members with chronic conditions (like diabetes or heart disease). They can help you:
Coordinate specialist care
Manage medications
Navigate insurance complexities
Access free or discounted health programs
If offered, these services can save time, money, and improve your health outcomes.
Keep Good Records
Mistakes happen. Always:
Review Explanation of Benefits (EOB) statements for errors.
Keep copies of medical bills and payment receipts.
Follow up on any denied claims—sometimes they can be appealed.
Staying organized helps prevent overpaying or missing important paperwork.
Pro Tips for Getting More Value from Your Plan
Here are a few additional strategies:
| Tip | Why It Helps |
|---|---|
| Schedule preventive care early in the year | Get the most value from your coverage and catch issues early |
| Plan elective procedures strategically | If you’ve met your deductible, end-of-year can be cheaper for planned care |
| Use urgent care instead of the ER for minor issues | Dramatically lower out-of-pocket costs |
| Take advantage of wellness incentives | Some plans offer gift cards or discounts for health activities (steps challenges, health screenings, etc.) |
Sources:
Final Thoughts on Getting the Most from Your Health Insurance
You’re already paying for health insurance—don’t leave valuable benefits unused. By understanding your coverage, using preventive services, staying in network, and taking advantage of financial tools like HSAs, you can stretch every dollar and protect your health.
A little effort up front leads to smarter care choices, lower costs, and better outcomes. Treat your health insurance like an investment—and make sure you’re getting the return you deserve.
