How to Get the Most Out of Your Health Insurance Plan

Preparing for and having a newborn involves a lot of medical attention for mother and child. Here's how you can maximize your health coverage.

• Use it for prenatal visits: Prenatal visits are essential because it's best to catch and manage any condition before it puts your pregnancy at risk. Your plan can cover the costs of these visits without a copay. You also don't need to go through your PCP for a referral to see an OB/GYN, nurse practitioner or midwife.
• See if you're eligible for Medicaid or CHIP: If you don't have health coverage when you find out you are pregnant, see if you qualify for Medicaid or CHIP. Unlike Marketplace plans, you don't have to wait for the Open Enrollment period to get health insurance. These can give you access to free or low-cost coverage.
• Determine if you qualify for special enrollment: If you don't qualify for Medicaid or CHIP, see if you do for a Special Enrollment Period. These require you to be undergoing a significant life event. Being pregnant will not qualify you, but giving birth does.
• Report your child's birth to the Marketplace: After giving birth, update your application as soon as possible. It may change your coverage options, resulting in lower monthly premiums. You can either add your baby to your current plan or enroll in a separate one for the remainder of the year. Remember, your baby's first year includes a lot of visits to a pediatrician.
• Get breastfeeding help: A Marketplace health plan can also cover consultations with a lactation consultant. It also includes equipment, such as breastfeeding pumps. The best part of this is you don't have to spend on copay.

A surgery always entails expenses but having health insurance can help minimize costs. Here are some practical ways to maximize your health plan benefits for planned procedures.

• Ensure your coverage: See if your health plan covers the procedure you want. Health insurance typically shoulders part of your surgery (or sometimes, the entire thing) as long as it's medically necessary. For example, your provider may cover elective cosmetic surgery like breast reduction if it helps alleviate back pain.
• Use pre-authorization: If your plan doesn't cover the procedure you want, check if it requires pre-authorization. If yes, your doctor must inform your health insurance company that the surgery is medically required before you have it. If your healthcare provider doesn't do it, prepare to foot the entire bill.
• Ask about discounts: More complicated procedures will typically cost more than simple ones. However, the costs can quickly increase because these involve surgical teams. Ensure that most, if not all, of your medical service providers are in-network. Even if your health plan covers the procedure, you'll still pay for out-of-network services.
• Time your procedure properly: Check your deductible to determine where you’re at in reaching it. Timing can considerably impact your expenses. See if you can schedule it when you hit your deductible (or are just about to). Once you've paid up to your deductible, your health insurance provider will share the remaining costs.

Health insurance is an excellent way of reducing possible physical therapy costs. However, before pushing through with your treatment, ask the following questions to ensure you’ve covered all your bases.

• What limits are in place? There are several limits to check with your health plan. Some only cover PT within the first three months. Others only pay for the service for a specific number of sessions. If the recommended duration of physical therapy exceeds your plan's limit, you know you'll need to pay at some point. Discuss your options with your physical therapist if you know that'll be challenging.
• Can you use out-of-network therapists? Your health plan type determines your flexibility regarding medical service providers. If you have an HMO or a PPO, you can only stay in-network if you want therapy covered. Plans that allow you to go with out-of-network therapists may have higher copays or coinsurance, so if your preferred therapist isn't within your network, you might want to calculate the difference in cost.
• Do you need a referral? Some health insurance plans require your primary care provider to issue a referral before covering a service. If you're unsure whether you need one, check with your provider. Getting a referral isn't complicated — simply tell your PCP you need one — but it's still an extra step. However, skipping it may cost you more money than it's worth.
• Is equipment covered? With physical therapy, your therapist may ask you to do some exercises while you're at home. Some of these are simple and are a matter of completing specific movements. However, others require equipment — these may range from resistance bands to Total Resistance Exercise (TRX) systems. Sometimes, even if your health insurance plan covers the actual session, it may draw the line at equipment. It's best to confirm it before purchasing home equipment.

Frequent doctor visits and regular medication can quickly dent your savings. Having health coverage doesn't mean you won't have to spend anything anymore, but it can help you reduce some costs. Here are some strategies you can apply.

• Take advantage of preventive care services: Check out your health plan’s wellness benefits. You can get discounts on gym memberships, have access to a weight loss counselor or join a cooking class. These may not reduce your direct costs, but you can use them to improve your overall health. That may eventually lead to a change in your medication or lessen the frequency of your doctors' visits.
• Choose a low deductible plan: You typically need more medical attention when dealing with a chronic illness. It translates to numerous doctor appointments, regular tests and medication — all of which cost money. A low-deductible health plan is a better option. Staying in-network (if required) ensures you'll reach your limit early. After that, your coverage kicks in, and your provider begins sharing in costs. It can reduce your medical expenses considerably.
• Maximize self-management programs: Living with a chronic disease can elicit feelings of hopelessness. Some programs focus on letting you build confidence in managing your condition. Believing that you can lead an active lifestyle helps patients' mental, emotional and physical well-being. You can also pick up techniques to nurture relationships with family and friends despite your condition.
• Consider maintenance medication: Most people with chronic illnesses also have prescribed maintenance medication as part of their healthcare regimen. Most health plans provide prescription drug coverage but don't cover all medicines. Consider it when you're choosing a health insurance plan. Pick a plan that covers your medication because it can help reduce expenses.

Although mental healthcare services are included in the 10 essential benefits of all plans in the Marketplace, keep the following things in mind to ensure you maximize your coverage.

• Confirm that the service is covered: Mental health treatment isn't limited to one-on-one therapy sessions with a psychologist or psychiatrist. It includes group therapy, addiction treatment, telemedicine and online therapy and psychiatric emergency services. Knowing these allows you to understand better what your plan can cover.
• Ensure you have a diagnosis: You may want to schedule sessions with a therapist for many reasons. You could have had a death in the family and are experiencing difficulty coping. Or you might be looking for ways to get out of a toxic relationship. Although all these are valid reasons, most health plan providers require services to be medically necessary before covering them. So it's best to have a formal diagnosis.
• Clarify the limits of your coverage: Determine what limits your plan set for mental health treatments. These could include having to stay in-network, requiring a referral or only covering a specific number of visits to your therapist. This way, you'll know what your plan covers and get an idea of how much you'll need to prepare for costs that you'll shoulder.
• Consider an HSA plan: Younger generations (especially Millennials) are more receptive to going to therapy than older generations. If you're one of them and your preferred therapist isn't in your plan's network, consider getting an HSA plan. You may have a high deductible, but you'll benefit from the low premium. You can also use your savings to pay for out-of-network service providers.