Mid-Year Check-In: Are You Taking Full Advantage of Your Health Insurance Coverage? 

KEY WEST, FL, August 15, 2024 – The midpoint of the year is a good time to review health insurance policies to ensure you will get the most out of plan benefits, especially if you have already met the annual deductible.

Many insurance plans will cover most, if not all, costs for eligible medical procedures and treatments once an individual meets the deductible and out of pocket maximum, making the second half of the year an opportune time to schedule any necessary or elective medical procedures that may have been postponed to reduce out-of-pocket expenses.

“We encourage individuals to take full advantage of the preventive care and medical services available through their health plans,” said David Clay, chief executive officer. “If you’re contributing toward your premium, it’s a ‘use it or lose it’ situation. The most cost effective way to get care is to utilize all of the benefits you’re entitled to before the year ends and deductible and out-of-pocket payment responsibilities reset.”

For example, someone who has a $2,000 deductible and a $4,000 out-of-pocket maximum is responsible for paying for many medical expenses until they reach the $2,000 threshold. Once they pass this mark, the insurer begins paying a larger portion of the cost of services eligible through in-network providers. When they reach the $4,000 out-of-pocket maximum, insurers will pay the total cost for eligible services.

Monthly premiums do not count toward deductibles, and in most cases, copays do not either. Once a new policy year begins, both deductible and out-of-pocket maximum contributions return back to zero.

Dr. Rocky Tingle, family physician with Keys Medical Group, highlights another critical aspect of leveraging health insurance benefits: preventive care.

“Regardless of whether your health insurance is through an employer, the Marketplace, or Medicare, preventive care is generally covered – including annual wellness appointments and immunizations”, said Dr. Tingle. “Many people skip an annual physical because they feel healthy, but these check ups can reveal underlying issues that might not yet show symptoms, when they are easier to treat.”

Key screenings, such as mammograms and colonoscopies, and elective surgeries, such as joint replacements and hysterectomies, may also be less expensive once you’ve reached your deductible. Plan early to give yourself time to schedule your procedure before the end of the year.

“We’re here to help patients make informed healthcare choices”, added Clay. “Our patient access team can provide financial estimates when a procedure is scheduled through One Call Scheduling at 305-292-9353.”

About: Lower Keys Medical Center is accredited by The Joint Commission in Hospital and Laboratory Programs, and as a Primary Stroke Center. The hospital is also accredited by the American College of Cardiology as a Chest Pain Center and by the Intersocietal Accreditation Commission in Echocardiography.

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