Maximizing your medical benefits should be at the top of your end-of-the-year to-do list.
It’s easy to start focusing on 2025 as many open enrollments gear up. However, reviewing your 2024 medical benefits is important, especially if your plan resents on January 1st.
First, have you and your dependents used your preventative services coverage?
Depending on your health plan, you may have a set of preventative services – such as check-ups, screenings and routine immunizations – that are 100 percent covered. And for women specifically, your mammogram screening and OB-GYN exam might be covered.
Be sure to take advantage of these annual benefits as there is still time to get needed appointments scheduled.
Next, make sure you have put your tax-free dollars to work.
In addition to reviewing your medical insurance coverage, don’t forget about the money you already have to pay for medical expenses.
If you have a flexible spending account (FSA) with any money left, use it. Your FSA dollars have a shelf life, and balances won’t carry over from year to year. Thus, it’s important to check your plan and review what eligible expenses are covered.
Unlike your FSA, if you have a health reimbursement account (HRA) or health savings account (HSA), your balance typically rolls over.
If your employer provides a health reimbursement account (HRA) to help pay for health care expenses, the money stays with you while you’re employed with the company. So, if you are planning to make a career change soon, consider using whatever’s left in your HRA now. Just make sure to review the list of eligible purchases, as some employers specify what you can use these dollars on.
Squirreling away those tax-free dollars in a health savings account (HSA)? Keep at it! If you do happen to have some last-minute expenses this year, you can use your HSA on deductibles, co-payments, coinsurance and other eligible health care costs. Money in these accounts roll over from year to year, and the dollars stay with you no matter your employer.
Be sure you understand your health care benefits and out-of-pocket maximums.
Deductibles determine the cost you pay out of pocket for health care services before your insurance kicks in.
“If you’ve met your deductible for the year, it’s a good time to consider any elective procedures you’ve been putting off, such as a joint replacement or surgery to repair a torn ligament,” Christopher Malone, DO, an orthopedic surgeon at Mercy Health — Springfield Orthopaedics, shares.
However, it’s important to first get an estimate on your out-of-pocket costs before scheduling any appointments. Out of pockets may be lower based on your benefit plans and if you have gotten treatments through the year toward your deductible. However, services might have co-pays or coinsurance until you reach your out-of-pocket maximum.
If you’ve met your out-of-pocket maximum or may reach it soon, consider scheduling those appointments or services. Once you have reached this dollar amount, most plans pay 100 percent of the allowed amount.
Dr. Malone also adds, “many people don’t realize that their medical benefits can cover elective procedures. But if you’re in pain or your condition is interfering with your daily life, an elective procedure may be the best way to improve your quality of life.”
Consider getting a custom price estimate using our online tool.
Did you know you can get an estimated price for more than 300 health care services using our online price estimator tool? Having this information at your fingertips can help you prepare for both your physical well-being and your financial well-being.
The price estimator tool customizes your results based on your insurance coverage/self-pay status, health care facility and more. This way, you can get a good idea of what something might cost. This information can help you prepare for upcoming procedures or services that are part of your care plan.
Prefer to talk to someone? You can also call 513-981-6445, Monday through Friday, from 7:30 a.m. to 6 p.m., to discuss your individual situation.
“Of course, you should always talk to your doctor before scheduling any elective procedure,” Dr. Malone shares. “They can help you decide if the procedure is right for you and discuss the risks and benefits.”
There is still time to get care before the end of this year! Find a Mercy Health primary care provider near you.
