The Art of Using Up Your Health Benefits By Year’s End

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Health insurance companies aren’t bashful about getting the most they can out of customers, in the form of premiums, co-pays, deductibles, and so on. So, as the end of the year nears, it makes sense to make sure you’re getting the most out of your policy—especially on stuff you’re entitled to for free, like annual preventive checkups, eye exams, and trips to the dentist.

A WSJ story is filled with tips and advice for maxing out your health benefits. There are a bunch of smart strategies, and it’s what you do at year’s end (and sometimes, at the beginning of the next year) that determine whether you’re really getting as much coverage as you can, and how much (or little) you’ll pay for it out of pocket. For example:

Carl Smollinger, 60, an insurance agent in Wexford, Pa., says he typically gets an annual physical, which his plan covers at 100%, in early November. By then, he’s often maxed out his deductible. So if the doctor decides he needs other tests or procedures that aren’t included in the preventive benefit, he has a few weeks to fit them in before the end of the year. “If you’ve burned through your deductible, it’s a perfect time to get all the physical stuff taken care of,” he says.

And this:

… you may want to slot medical work for the end of the year that extends into next year. That strategy can be effective if your plan has an annual limit on certain benefits—a set number of sessions of physical therapy or counseling, for instance.

Insurers play games all the time with how much they’ll cover and when they’ll cover it—that is, if they’ll cover it at all. So, tit for tat, you’ve got to play games too. Like by spreading out a patient’s dental cleaning over two visits, one before New Year’s and one after:

Matthew Messina, a dentist in Fairview Park, Ohio, says he often performs deep-cleaning procedures over two sessions, doing half of the patient’s mouth in December and the other half in January. That way, the person can take advantage of two years’ benefits and not waste any of the payout. “Once it’s gone, it’s gone,” says Dr. Messina, who is a consumer advisor to the American Dental Association.

If you’re thinking this is a silly model of waste and inefficiency, you’re right. It is. But hey, that’s the system. Your job is to figure out how to work it.

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