The Most Common Out-of-Pocket Expenses

• Copays / Coinsurance: A fee for seeing your doctor or another medical professional.
• Premium: The monthly cost of your plan.
• Deductible: The amount you need to pay before your insurance starts paying.
• Out-of-network providers: Unless you get it pre-approved, out-of-network care could include a higher deductible or limited recognition of claims.
• Non-covered services: Including some prescription drugs, medical devices, elective lab work, and more.

Note: In 2022, your marketplace health insurance plan has an out-of-pocket maximum of $8,700 for an individual and $17,100 for a family.  

1.) Know Your Network, and Stay in It

This one sounds simple, but the truth is, medical provider networks are full of complicated loopholes that could have you paying hundreds, if not thousands more for medical care. Staying in-network not only means using the right hospitals and facilities but also making sure that the professional giving treatment is also in-network.

Lab work is another service that must be in-network to qualify for coverage. Just because your doctor orders lab work doesn’t necessarily mean that they will use an in-network lab.

2.) Use Your Preventive Care Benefits

Unsurprisingly, staying healthy is perhaps the most effective way to reduce healthcare costs. But even if you’re feeling good, seeing the doctor regularly can help catch unexpected illnesses and conditions before they get worse.

Your health insurance plan includes a number of essential care benefits, including preventive doctor office visits, health screenings, and more.  

3.) Call Your Telehealth Doc First

In response to the pandemic, telehealth programs have been upgraded across the board. No matter which health insurance company you’re enrolled in, your plan comes with some form of telemedicine.

With a tele-health appointment, you can reach a medical professional for easy, actionable advice without having to go to the doctor. You can also get some prescriptions refilled via telehealth, and many online appointments can have a $0 copay.