As the year draws to a close, many of us are updating our benefits plans and all the changes can be confusing. If your health plan is changing, it pays to know what's in your new plan's fine print.
"Start with what you already know," advises Dr. Jackie Eghrari-Sabet, of Family Allergy & Asthma Care in Gaithersburg, Md. "You already know which medications you're on, so find out how much that's going to cost you in the coming year."
After figuring out how much the insurance company will charge you, you should also find out if your medication will be approved, then determine how you're going to get the medicine, whether at your local pharmacy or through a pharmacy that delivers by mail.
"There are some insurance companies that would really prefer you use a mail order pharmacy," Dr. Jackie said. "That process can take up to two weeks. That means you're gonna need to be able to plan ahead in order to get your prescriptions."
You'll also need to be familiar with your new plan's other benefits, like testing. Know whether or not your insurance will even cover that. Some plans cover it with a separate co-pay or a separate deductible. Then there's lab work.
"There is rarely the plan that allows you to simply pay one price," Dr. Jackie said. "You're usually paying a percentage of each and every lab test, so you need to know which labs are being done."
When it comes to repeat visits to your doctor, know how many visits are covered. Your specialist may want to see you again in a week for a followup appointment, but your insurance company may not allow that followup, or frequent visits at all.
If you are supposed to get a referral to see a specialist, know that it's your responsibility as the patient to get the referral.
"However, remember that you must get those magic pieces of paper from your primary care physician," Dr. Jackie said. "You can't just show up at the specialist's office and expect to be treated."
If you have money left in your flexible spending account, start thinking about things like over-the-counter medications that you can pay for with those funds.
"Go fill up on that medication now, whether it's for allergies or reflux," Dr. Jackie advises.
In addition, remember that you'll often need a doctor's note for those meds to qualify as flex-spending expenses.
Finally, if you still need that yearly checkup, hop to it!
"Just like hairdressers before New Year's Eve, we get really busy at the end of the year," Dr. Jackie said.
So make that appointment now!