Health insurance is more than help during a crisis. It acts like a steady tool that keeps small health problems from turning into big ones. Many plans include useful extras that people do not notice. These extras can save money, reduce hassle, and make care easier to get. In this article, we’ll point out ten perks that often sit quietly in your plan. We’ll explain them in simple words and show the small steps that make a big difference. You’ll see terms such as deductible, copay, coinsurance, and out-of-pocket max. Once you know how these work, you can use your plan better and keep more money in your pocket.
Free Yearly Checkups And Essential Screenings With Plans
Most plans include preventive care at no extra cost when you see an in-network doctor. This often covers a yearly physical, basic blood work, blood pressure checks, and age-based screenings. Why is this free? Under federal rules, many preventive services with an “A” or “B” rating are paid at 100% when billed with the right CPT and ICD-10 codes, and no other problems are treated. That means no copay or deductible for the visit if it is only preventive.
Common items include:
- Vaccinations, flu shots, and some boosters
- Cholesterol, diabetes (A1C), and certain cancer screenings
- Counseling for quitting smoking or weight concerns
Tip: Book your annual visit early in the year. Use the Explanation of Benefits (EOB) to confirm it was processed as preventive. If you were charged, ask the office to rebill with preventive codes if the visit truly fit that purpose.
Immunizations And Boosters are Covered Without Extra Cost
Shots do more than protect kids. Many adult vaccines are also covered with no extra charge when done in-network. Plans often pay in full for shots like flu, COVID-19, Tdap, and shingles at a clinic or pharmacy.
Here’s how to get the most from this perk:
- Check your plan’s network list. Pharmacies often count as in-network sites.
- Ask the provider to bill the vaccine administration code and the specific vaccine code so it processes correctly.
- Keep your shot record. Many employers and schools ask for proof.
For travelers, some plans cover travel vaccines at partial rates. If a vaccine is out of network, you may pay more or face balance billing. Always ask the price first and, if needed, request an in-network referral.
Telehealth Visits Save Time, Money, And Stress
Telehealth is not just for urgent coughs. Many plans cover video or phone visits for primary care, mental health, nutrition, and even some chronic care checks. Costs can be lower than office visits, and there is no travel time.
Typical telehealth perks include:
- Evening or weekend hours for after-work care
- E-prescriptions sent to your in-network pharmacy
- Follow-ups for lab results or dose changes
Check if your plan has a preferred telehealth platform. Using the plan’s partner can mean a lower copay or even a $0 fee for certain visit types. Keep a list of your meds and recent readings (like blood pressure) ready. Many platforms let you upload photos of rashes, forms, or device logs for the doctor to review.
Mental Health Therapy And Substance Use Support Included
Your plan likely includes behavioral health benefits: therapy, psychiatry visits, and treatment for substance use. These services are often covered at the same level as medical care due to parity rules.
You may see:
- Talk therapy (individual, couples, family)
- Group therapy or intensive outpatient programs
- Virtual therapy platforms with evening slots
Check your EAP (Employee Assistance Program) if offered at work; it may include several free sessions. For ongoing therapy, confirm the provider is in network to use your copay or coinsurance. If sessions are denied, ask about appeals and what notes or treatment plans are needed. Keep all EOBs and appointment records—these help if you need a review of benefits later.
Maternity Care And Newborn Checkups After Birth
Many plans include prenatal visits, standard ultrasounds, lab tests, the hospital stay, and the first newborn checkups.
You will still have costs like a deductible or coinsurance, but you also get key protections:
- Global maternity billing groups many prenatal visits under one charge for simpler costs.
- A 48-hour hospital stay (longer for C-section) is common.
- A newborn is often covered under the birth parent’s plan for the first 30 days, but you must add the baby to a plan within that window.
Ask about pre-registration with the hospital, which can reduce surprise bills. If you use a midwife or birth center, check network status. For breast pumps, many plans cover one basic pump per pregnancy; ask your plan for the approved vendor list before buying.
Lower Drug Costs Through Formularies And Generics
Drug savings often hide in the formulary, which is the plan’s drug list with tiers.
A common setup is:
- Tier 1: generics (lowest copay)
- Tier 2: preferred brands
- Tier 3+: non-preferred or specialty drugs
Ask your doctor if a therapeutic equivalent exists on a lower tier. Your pharmacist can also request a switch to a generic with your okay. If your drug needs prior authorization or step therapy, the doctor must send notes first. For high costs, look at 90-day fills by mail and manufacturer coupons where allowed. If you have a High Deductible Health Plan (HDHP) with a Health Savings Account (HSA), paying with HSA dollars can cut taxes on many prescriptions and supplies.
Protection From Huge Bills With A Yearly Limit
A key shield in your plan is the out-of-pocket maximum (OOPM). Once your combined deductibles, copays, and coinsurance reach this max in a plan year, the plan pays 100% of covered in-network care for the rest of that year. This cap does not include premiums or non-covered items, but it stops a bad year from becoming a debt spiral.
To use this well:
- Keep care in network when you can, since out-of-network may have a separate, higher max.
- If you are close to the max, finish needed care in the same year.
- After hitting the max, schedule remaining tests or therapy before the year ends.
Know your plan type: HMO/EPO usually need in-network care; PPO allows more choice but can cost more out of network.
Pre-Approvals And Case Managers For Tough Care
For surgeries, infusions, or imaging like MRI/CT, your plan may need prior authorization. While it can feel like extra work, it helps confirm the service is covered and the site is in network. Many plans also offer case management when you face a complex condition.
A nurse or social worker can:
- Coordinate referrals and follow-ups
- Help schedule the lowest-cost in-network facility
- Explain home health, hospice, or rehab choices
Ask your plan if you qualify for a case manager. Keep records: dates, names, and reference numbers from calls. If an authorization is denied, request the denial letter, learn the exact reason, and file a timely appeal with supporting notes from your doctor.
Second Opinions, Rehab, And Medical Equipment Help
You can often get a second opinion before major treatment, sometimes at no cost if you use a designated center. If you need rehab—like physical therapy (PT) or occupational therapy (OT)—plans may cover a set number of visits each year. Ask about visit caps and whether home exercises can reduce office sessions. For durable medical equipment (DME)—think crutches, CPAP, or a knee brace—plans may pay when ordered by an in-network doctor and filled by an approved DME vendor.
Quick checks:
- Make sure the therapist and the facility are both in network.
- Ask if the device is rental vs. purchase and who handles repairs.
- Keep receipts and serial numbers for warranty and replacement.
Special Rights After Job Change Or Life Events
Big life changes unlock special plan rights. If you lose job coverage, COBRA lets you keep the same plan for a time (you pay the full premium plus a fee). A Special Enrollment Period (SEP) also opens when you have events like marriage, birth, adoption, a move, or a major income shift. You usually have 60 days to pick a new plan.
Steps to follow:
- Ask your old plan for a certificate of creditable coverage (proof of past coverage).
- Compare marketplace plans and check your current doctors’ networks.
- Use your EOBs to guess next year’s costs and pick a plan with the right deductible and OOPM.
Mark deadlines on a calendar. Missing them can lock you out until the next open enrollment.
Tax Perks With Hsas And Fsas Save Money
Some plans offer HSA or FSA options that use pre-tax dollars for care. With an HSA (paired with an HDHP), your money:
- Goes in tax-free
- Can be invested and grow tax-free
- Comes out tax-free for qualified medical costs
Unused HSA funds roll over year to year and stay with you if you change jobs. An FSA also uses pre-tax dollars but usually has a “use-it-or-lose-it” rule, with a small rollover or grace period if your employer allows it. Eligible costs can include copays, deductibles, dental, vision, and many over-the-counter items. Keep your receipts and save your plan’s eligible expense list for quick checks at checkout.
Conclusion
Health insurance carries many small features that add real value when used well. From preventive visits and vaccines to drug savings, HSAs, and special enrollment rights, each perk can lower bills and make care easier to get. If you want help choosing or using a plan, Boro Insurance Agency can explain options in clear steps and support your choices. We offer health insurance for individuals, families, and small groups. With the right plan details in hand, you can keep your costs steady and your care simple.
