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Maximizing Your Health Benefits with MS

By Matt Cavallo

Many of us have health insurance plans with deductibles. A deductible is the amount of money that you pay before insurance starts to pay for covered services. For example, if you have a deductible of $1,000 dollars, you pay the first $1,000 for covered expenses. Once you have met the deductible, insurance pays for the majority of covered health services and you may have a copay or coinsurance to cover the remaining balance up until you reach your out-of-pocket maximum. Once you reach your out-of-pocket maximum, health insurance companies pay 100 percent for covered health services.

Why is this important? Many of us living with multiple sclerosis are on costly treatments and require numerous specialist appointments and tests throughout the year. If this is the case for you, you have probably met your deductible, or are close to your out-of-pocket max. That means that for the rest of the year, until your benefits reset on January 1, covered healthcare services should be less expensive, or if you have reached your out-of-pocket max, no charge to you at all. 

Can I plan my covered health services to maximize my healthcare spend? Absolutely. Not only that, but there are ways to get some of your covered services paid for so that you can meet your deductible, and even your out-of-pocket max, quickly. Here are some tips to help maximize your out-of-pocket spending for covered health services:

* Stack appointments, treatments and infusions for MS at the beginning of the year. For example, I typically have a neurology appointment, MRI and infusion scheduled in January. This means that I will pay a big chunk of my deductible upfront so that I can quickly meet my deductible.

* Get enrolled in financial assistance programs through your pharmaceutical company. MS treatments are expensive and many pharmaceutical companies offer financial assistance to those who qualify. The income threshold is high for these programs, so don’t think that just because you earn a decent wage you won’t qualify. The best thing to do is reach out directly to the manufacturer and ask for financial assistance. Whatever financial assistance you are provided counts towards your deductible, even if you spent zero out-of-pocket. 

* Call your insurance company’s customer support to learn your deductible and out-of-pocket max balances. Flip over your health insurance card. On the back, you will see a toll-free number for customer service. Call that number to get information on how much you have left on your deductible or if you have reached your out-of-pocket max. Note, if there are claims pending, the customer service rep may not have access to that information. They can tell you where you are at based on processed claims. 

If you are able to maximize your out-of-pocket spending at the beginning of the year, towards the end of the year you will reap the benefits. Once you hit your out-of-pocket max for the year, insurance pays 100 percent for covered health benefits. Meaning if you are at that point and have been putting off appointments because of cost, then this is the time to take advantage of it before the benefits reset on January 1. 

So, if you have been putting off physical therapy, your podiatrist or dermatologist, this may be a great time to get those appointments in. Do you have labs due or are you thinking about allergy testing? This may be a great time of year to get those kinds of appointments in for either low or no cost to you depending on where you are with your health insurance spend to this point.

Now, if you have recently switched jobs and have new benefits or have an insurance type that doesn’t run off of the deductible, copay, and coinsurance, this may not be for you. If you are managing your deductible and do have this type of health insurance, call your insurance customer service representative to see where you are at in terms of your deductible and out-of-pocket max. You never know, you may be able to catch up on all of those appointments you have been putting off and save some money in the process.