How to Get the Most from Your Healthcare Coverage

In this article:

• Getting the most from your healthcare coverage means understanding costs, getting care when you need it, and taking advantage of covered benefits that can additionally support your health and well-being.
• Check your options before it’s time to enroll in a plan so you can choose the right coverage for yourself and any dependents. 
• Read your plan documents carefully so you know what’s covered and how costs work.
• Get to know your primary care doctor, know where to go for other care, and consider timing of medical procedures to maximize your benefits.
• Look into programs that can support long-term health, like preventive care, ongoing care for chronic conditions, and digital health options to provide care outside of the doctor’s office.
• Your coverage can also include mental health assistance. 
• Lark can support you 24/7 as you make healthy choices to lose weight and manage blood sugar, blood pressure, or other conditions with or without GLP-1s.

Health insurance can help you pay for healthcare, but are you getting everything you can from your coverage? Between costs, benefits, providers, and insurance companies, the healthcare system is complicated - and you may not be making the most out of your coverage.

Taking a few minutes to understand the basics of health insurance, your plan, and how to use it can be worth the time and effort. You may find additional services like preventive programs and digital, phone-based programs that you didn’t even know were available to you. Here are some ways to help you get the most out of your healthcare coverage. 

1. Review your options before your enrollment period opens.

There are only certain times when you can enroll for a healthcare plan or choose a new one, according to the Kaiser Family Foundation. Try to review your options before the enrollment window, or enrollment period, opens. That way, you can choose the right plan for you and your family during the enrollment period.

Check aspects like costs and benefits. You might also ask yourself certain questions that can help you identify changes in your medical needs. Here are examples. 

• Has your plan’s network changed?
• Do the doctors you see accept the plan you’re considering enrolling in?
• Have you had changes in your health that make you see a doctor more or need more medications?
• Do you need a plan that helps pay for more, or is it more important to reduce monthly costs?
• Have you had changes in your job or family - such as a marriage or divorce?

Examples of when people can enroll for a healthcare plan include Medicare enrollment during a 6-month window when you turn 65 years old or enrolling for a plan on the national exchange or through your employer during an annual open enrollment period. 

2. Read and understand your plan before you need it

Your plan comes with several documents. They have important information, such as the following.

• What your benefits are - like which doctor’s visits, ongoing care services, and preventive care programs you are entitled to
• How much you may need to pay out of pocket as a co-pay for certain services
• Which providers take your insurance
• How to get specialty services when you need them
• Which prescription drugs are covered - check your “formulary”

It’s important to understand your plan before you need it so that if you do need medical services, you know how to get them and what you might expect to pay.

There are a lot of special terms in healthcare insurance plans. Here are some that you should know. They can help you understand your plan documents, coverage, and costs.

Terms from CMS

Know your primary care physician (PCP).

Your primary care physician, or PCP, plays an important role in your healthcare. Choose a PCP whom you feel comfortable talking to. Often, getting referrals from friends and family can lead you in the right direction.

Your PCP may be the first one you go to when you have a concern, and he or she may give you referrals to specialists. Your PCP can also be someone who can keep you healthy when you go for regular annual check-ups. These are good times to ask your PCP any questions or bring up health concerns. You can also ask about any preventive services that can benefit you. 

Know where to go for care and how to submit claims.

Your PCP may not be able to meet all of your healthcare needs. Other needs may include getting care from specialists like endocrinologists or cardiologists, mental health professionals, or nurses. You may have inpatient or outpatient procedures in a hospital, or join preventive programs. 

It’s important to know where to get the services you need and which providers accept your health insurance. Otherwise, you may be stuck paying extra if you go out of network for services. It’s also good to know how to submit insurance claims and file an appeal if needed. Your health insurance provider can help answer these questions. 

Check covered preventive services and perks.

The Affordable Care Act (ACA) requires that health plans offer certain preventive services, according to the Department of Health and Human Services (DHHS). Medicare also offers a range of preventive services to eligible beneficiaries. Preventive care isn’t always top of mind, but it can help you stay healthy or get treatment early. 

These are some types of preventive care that may be available to eligible beneficiaries.

• Certain vaccines like COVID-19 and flu vaccines
• Screening for early detection of conditions like certain cancers and diabetes
• Support programs to help with healthy lifestyle choices

The Diabetes Prevention Program (DPP) and Medicare Diabetes Prevention Program (MDPP) are examples of preventive services. They’re structured programs to help eligible individuals with prediabetes prevent or lower their risk for type 2 diabetes by making healthy lifestyle changes like losing weight and being physically active. People in Lark’s DPP and MDPP access the program through their smartphone anytime for benefits like these.

• Personalized coaching
• Logging and tracking
• In-the-moment feedback
• Education in bite-sized chunks
• Encouragement

Many health insurance plans include additional perks like discounts on gym memberships, nutrition counseling, fitness apps, or other wellness services or products. 

Know options for ongoing care - including telehealth solutions

Ongoing care can help avoid more serious complications if you have a chronic condition - like 3 in 4 American adults do. Telehealth, or care delivered remotely like through phone calls, a web portal, or smartphone apps, can make it easier and more convenient to connect with providers.

Additionally, many chronic conditions can be better managed by daily choices you make on a daily basis, like what you eat, how active you are, whether you take your medications as prescribed, and if you monitor measures like blood sugar or blood pressure as recommended. Many health insurance plans include ongoing care solutions. Lark, for example, offers digital coaching to help manage conditions like hypertension and diabetes.

Use mental health benefits

Mental health benefits are essential if you have a diagnosed mental health condition - but your plan may cover even more. Some plans may cover counseling, therapy, stress management programs, and other services to support mental and emotional well-being. Often, they are available virtually - so you can access them from home.

Lark Can Help

You’re paying for healthcare coverage - so make sure you get the most from it! Compassionate, personalized coaching can help you reach your weight loss and health goals - and you may be eligible for Lark’s digital coaching at no cost to you. Your Lark coach is available 24/7 for encouragement, nutrition and physical activity coaching, and habit tracking. Lark can help you make healthy choices and establish habits that fit into your lifestyle so you can lose weight and keep it off with or without GLP-1 medications. 

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Click here to see if you may be eligible to join Lark today!

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