I’ve just hit my health insurance maximum out-of-pocket—what can I access for “free” now?
I had surgery earlier this month, and even with the “discount,” my 20% share of the bill exceeded my out-of-pocket limit. I’ve already spent thousands on healthcare this year, and with physical therapy on the horizon, my expenses will only increase.
This is my first experience with hitting my maximum out-of-pocket, as well as one of my first times meeting my deductible. What services are now available without additional cost? I believe some copays, like for doctor visits, will still be around $20 or so, and dental expenses will obviously be separate.
Are there preventative services I should consider scheduling now that I won’t have to pay extra for, especially since some may tend to be costly but are important for my health? To clarify, I’m not looking for unnecessary procedures, but rather for essential care that our healthcare system often discourages people from pursuing regularly.
For context, I might be changing jobs in a couple of months, which will reset my benefits before the year ends. So, I’d like to figure this out soon.
I live in New York and have a PPO plan.
Congratulations on reaching your maximum out-of-pocket! It can be overwhelming navigating what benefits you now have access to, but you’re in a good position to take advantage of your coverage. Here are a few things to consider:
Covered Services: Most plans will cover additional medical services without any cost-sharing now that you’ve hit your out-of-pocket maximum. This typically includes services like doctor visits, specialist appointments, and diagnostic tests. Make sure you confirm with your insurance provider what specific services are classified as “free” for you.
Preventive Care: According to the Affordable Care Act, many preventive services are fully covered, so you may want to take advantage of things like vaccinations, cancer screenings, and annual check-ups. Check what preventive services your plan lists as covered to ensure you’re utilizing your benefits.
Physical Therapy: Since you mentioned you’ll be undergoing physical therapy, this should be fully covered as well, assuming those visits are part of your prescribed treatment plan. Be sure to confirm with your provider before scheduling.
Mental Health Services: If you haven’t used mental health services, check if therapy or counseling is covered without cost, especially if you’ve been considering it.
Chronic Condition Management: If you have any chronic health conditions that require management, now may be a good time to schedule appointments and tests that you might have been putting off due to cost.
Specialist Referrals: If there are specialists you’ve wanted to see for ongoing health concerns, you can utilize those visits without worrying about the copays.
Diagnostic Imaging: If you have any imaging tests such as MRIs, X-rays, or CT scans you’ve been postponing, these may be fully covered now as well.
Second Opinions: If you’re considering any significant health decisions, you might look into getting a second opinion without additional costs.
Wellness Programs: Check if your insurance offers any wellness programs or services like nutritional counseling, fitness programs, or screenings that are fully covered or at low costs.
Before you schedule anything, it’s a good idea to call your insurance company to clarify which services are covered in full and whether there are any specific rules or requirements. Also, keep in mind your potential job change, as different plans may have different benefits. Take full advantage of the coverage while you have it!