You are paying monthly insurance premiums.
But is there more than meets the eye, and are you actually getting everything you’re paying for?
Most people aren’t. Each year, millions of Americans never use their full insurance benefits. They skip covered screenings. They miss reimbursements. They overpay for prescriptions. They fail to ask the right questions.
That’s money gone. Every single year.
The good news? You don’t have to be a finance whiz to make this right. You just have to know where to look and what to ask.
So, if you want to stop leaving money on the table and start getting the full value of what you are already paying for, this guide takes you through 10 powerful ways to maximize insurance benefits.
Way No. 1: Treat Your Explanation of Benefits Like a Bank Statement
The vast majority of people just throw their Explanation of Benefits (EOB) out without even opening it. That’s a costly mistake.
Your EOB is not a bill. It’s an itemized statement from your insurer of precisely what was charged, what was covered, and what you owe. It’s one of the most potent tools at your disposal — and it doesn’t cost a dime.
What to Look for in Your EOB
Each time you get an EOB, verify these critical things:
- Was the claim adjudicated under the accurate plan?
- Did any charges get denied that should have been covered?
- Does what you owe equal what the provider billed?
- Were any services coded incorrectly?
Mistakes in EOBs occur more frequently than you might expect. The wrong billing code can make a covered service an out-of-pocket cost overnight.
If something seems off, call your insurer and have them explain it to you line by line. You have that right. Use it.
Way No. 2: Take Advantage of All the Free Preventive Care Benefits to Which You’re Entitled
Here’s something that most people don’t know: under the Affordable Care Act, most health insurance plans are mandated to provide preventive care at no charge to you.
That means no copay. No deductible. No out-of-pocket expense. Completely free.
What Counts as Preventive Care?
| Service | Who It’s For |
|---|---|
| Annual wellness exam | Everyone |
| Blood pressure screening | Adults |
| Cholesterol screening | Adults at risk |
| Colorectal cancer screening | Adults 45 and older |
| Mammograms | Women 40 and older |
| Vaccines (flu, shingles, etc.) | Age-based eligibility |
| Depression screening | Adults and adolescents |
| Diabetes screening | Adults at risk |
| Cervical cancer screening (Pap smear) | Women |
| Well-child visits | Children and teens |
You might use one or two of these a year, at most. That’s a missed opportunity.
Call your insurer and ask: “What preventive care services do I get free of charge?” Then schedule them. Every unused screening is a benefit you already paid for — gone to waste.
Way No. 3: Stop Overpaying for Prescriptions
If you’re paying cash for prescriptions at full price and not checking out your options, you are very likely overpaying.
It’s one of the quickest and simplest ways to get more out of your insurance without making any changes to your coverage.
4 Ways to Lower Your Prescription Costs Right Now
Check your formulary first. Every insurance plan is based on a drug formulary — a list of covered medications assigned to cost tiers. Brand-name drugs can be five to 10 times more expensive than their counterparts. A lower-tier generic may be available — ask your doctor.
Use GoodRx or similar tools. Sometimes the GoodRx cash price is lower than your insurance copay. Always compare before paying.
Ask about manufacturer coupons. Some pharmaceutical companies have patient assistance programs or coupons that can reduce the price of brand-name drugs significantly.
Use mail-order pharmacy. Many insurers will provide a 90-day mail-order supply for less on a per-dose basis than monthly retail fills.
A single conversation with your doctor or pharmacist can save you hundreds of dollars each year just in prescriptions.
Way No. 4: Strategically Hit Your Deductible — and Go All In
Your deductible is the amount that you pay out of pocket before your insurance coverage fully kicks in. After that, your insurance usually pays for most of the rest.
This is something most people do not think of strategically. They should.
The Smart Deductible Strategy
Keep track of your deductible status throughout the year. If you’re close to hitting it in October or November, that’s when you should schedule:
- Elective procedures that you’ve been delaying
- Specialist visits
- Physical therapy
- Imaging or lab tests
- Dental work (if under the same plan)
Conversely, in January, if you are nowhere close to your deductible, hold off on non-urgent procedures until later in the year if you can — unless the condition is serious.
Timing your medical care around your deductible is perfectly legal, practical, and one of the smartest financial moves you can make with your insurance.
Way No. 5: Know When You Are In-Network or Out-of-Network — Before You Go
This single mistake costs people thousands of dollars annually.
Going out of network — even inadvertently — can mean paying double or triple what a procedure would otherwise cost you. In some cases, your insurance won’t cover it at all.
A Quick Comparison
| Factor | In-Network | Out-of-Network |
|---|---|---|
| Cost to you | Lower — negotiated rates apply | Higher — full price or percentage |
| Deductible | Counts toward in-network deductible | May have separate, higher deductible |
| Coverage | Full coverage per your plan | Partial or no coverage |
| Surprise bills | Less common | More common |
What to Do Before Each Appointment
Always call your insurer and confirm that your specific provider — not just the hospital or clinic — is in-network. Doctors can work at in-network facilities but bill separately as out-of-network.
At the front desk, ask: “Will all my providers today be billing in-network with my plan?”
A single phone call before your visit can spare you an enormous bill afterward.
Way No. 6: Appeal Every Claim That Gets Denied — Most Are Overturned
A denied claim is not the end of it. Not even close.
According to the Kaiser Family Foundation, about 17% of in-network claims are denied each year — but when patients appeal, a significant percentage of those denials are overturned.
The system is predicated on the idea that most people won’t fight back. Prove them wrong.
How to Appeal a Denied Claim
Step 1 — Request the denial reason in writing. You deserve a clear explanation of why your claim was denied.
Step 2 — Review your plan documents. Check whether the service is listed as covered. Look for the exact language.
Step 3 — File an internal appeal. Submit a formal written appeal with supporting documentation — doctor’s notes, medical records, and a letter of medical necessity if applicable.
Step 4 — Request an external review. If your internal appeal is rejected, you are entitled to an independent external review. This is a federally protected right under the ACA.
Step 5 — Contact your state insurance commissioner if the insurer still won’t cooperate.
A denial letter doesn’t have to be the final word. It rarely needs to be.
Way No. 7: Take Advantage of Benefits You Didn’t Know Existed
Many insurance plans come with added perks that no one tells you about. These benefits are buried in the fine print — and most policyholders never use even one.
Hidden Benefits Worth Checking Right Now
Mental health coverage. Under federal parity laws, mental health services must be covered at the same level as physical health services. Therapy, counseling, and psychiatric care could cost you far less than you realize.
Telehealth visits. Many plans now offer virtual doctor visits with a lower copay than in-person visits — sometimes at no charge.
Vision and hearing discounts. Even if vision or hearing isn’t fully covered by your plan, it may include discount programs on glasses, contacts, or hearing aids.
Fitness and wellness reimbursements. Some plans reimburse members for gym memberships, fitness trackers, or wellness programs. Check your plan documents for “wellness benefits.”
Chiropractic and acupuncture. These services are now included in more plans than ever, particularly for back or neck pain.
24/7 nurse hotlines. Many plans offer free 24/7 access to a registered nurse by phone. That can prevent an unnecessary urgent care visit.
Call your insurance company and ask: “Can you walk me through all the extra benefits included in my plan?” You may be surprised by what is already covered.
Way No. 8: Use a Health Savings Account (HSA) to Double Your Money
If you have a high-deductible health plan (HDHP), you’re probably eligible for a Health Savings Account — and if you aren’t using one, you’re missing out on a major tax advantage.
Why an HSA Is One of the Best Financial Tools You Can Use
An HSA allows you to contribute money on a pre-tax basis to cover qualified medical expenses. That means you never pay income tax on that money — not when you earn it, not when it grows, and not when you spend it on healthcare.
That’s a triple tax advantage that no other account offers.
| HSA Feature | Details |
|---|---|
| 2024 contribution limit (individual) | $4,150 |
| 2024 contribution limit (family) | $8,300 |
| Tax on contributions | None |
| Tax on growth | None |
| Tax on qualified withdrawals | None |
| Rollover year to year | Yes — no “use it or lose it” |
| Investment options | Available at many providers |
If your employer also contributes to your HSA, that’s free money on top of it.
Contribute the maximum amount to your HSA every year if you can. The money rolls over, grows tax-free, and can be invested. After age 65, the money can be used for anything — not just healthcare.
Way No. 9: Review and Update Your Coverage Each Open Enrollment Period
Open enrollment is the only time each year when you can change your insurance plan without a qualifying life event. The vast majority of people click through in five minutes and choose the same plan they had last year.
That’s a mistake.
Your health needs change. Your financial situation changes. And insurance plans change too — benefits are added, networks adjusted, and premiums increase.
What to Review During Open Enrollment
Your premium compared with your actual usage. If you rarely need healthcare, a lower-premium high-deductible plan might be cheaper overall. If you have chronic conditions, a higher-premium plan with lower copays may be the smarter choice.
Your prescriptions. Check that your medications remain on the formulary and at the same cost tier.
Your providers. Verify that your doctors, specialists, and preferred hospitals are still in-network.
New benefits added to the plan. Insurers can add telehealth, mental health, or wellness benefits during the year.
Your life changes. Got married, had a baby, or started working from home? Your coverage needs could have shifted drastically.
Compare plans side by side for at least an hour during open enrollment. A little effort now can save you thousands in the year ahead.
Way No. 10: Team Up With a Patient Advocate or Benefits Coordinator
You don’t have to navigate the insurance system alone.
Patient advocates and benefits coordinators are professionals trained specifically to help people get the most out of their insurance coverage. They know the system, they know the language, and they know where the loopholes are.
Who Can Help You
Hospital-based patient advocates — Most hospitals employ them. They can help you understand your coverage, appeal denials, and locate financial assistance programs.
Independent patient advocates — These are privately hired professionals who work entirely in your interest. In complex cases, they often save clients far more than their fee.
Insurance brokers — A quality independent broker can help you compare plans objectively and identify coverage that truly meets your needs.
Nonprofit organizations — Organizations such as the Patient Advocate Foundation provide free assistance to help people navigate insurance disputes and claims.
Whether you have ongoing coverage questions, need financial planning around healthcare costs, or want help maximizing every benefit available to you, Global Health Financial offers expert guidance and resources designed specifically for your situation.
The Big Picture: How Much Can You Actually Save?
Let’s put it all together. Here’s a rough estimate of what each strategy could save you per year:
| Strategy | Potential Annual Savings |
|---|---|
| Using all preventive care benefits | $500 – $2,000 |
| Switching to generic prescriptions | $300 – $1,500 |
| Avoiding out-of-network providers | $500 – $5,000+ |
| Appealing a denied claim | $200 – $10,000+ |
| Using hidden plan benefits | $100 – $1,000 |
| Maximizing HSA contributions | $500 – $1,500 (tax savings) |
| Timing care around your deductible | $200 – $2,000 |
| Choosing the right plan at open enrollment | $500 – $3,000 |
Put together, a well-informed patient can potentially save $3,000 to $10,000 or more each year — simply by using benefits they’re already paying for.
Mistakes That Quietly Drain Your Insurance Value
Before you move forward, watch out for these common pitfalls:
Assuming something isn’t covered without checking. Always verify before assuming you’ll be paying out of pocket.
Missing the open enrollment window. If you miss it, you’re locked in for the year unless a qualifying life event occurs.
Failing to keep records of calls and claims. Document every interaction with your insurer — dates, names, reference numbers.
Forgetting to update your plan after major life transitions. Marriage, divorce, a new baby — all of these change what coverage you need.
Letting FSA funds expire. Unlike an HSA, a Flexible Spending Account has a “use it or lose it” rule. Spend your FSA balance before the deadline.
Every year, millions of Americans are underinsured or fail to get the full value of their existing benefits, according to the Kaiser Family Foundation — underscoring the importance of being well-informed during enrollment and actively managing your benefits.
FAQs: Maximizing Insurance Benefits
Q: How can I find out exactly what my insurance plan covers? Start with your Summary of Benefits and Coverage (SBC) — your insurer is required to provide this. You can also call the member services number on your insurance card and ask them to walk you through your benefits.
Q: What should I do if my insurer denies a claim I believe should be covered? Request the denial in writing, then submit a formal internal appeal with supporting documentation from your doctor. If that doesn’t work, you are entitled to request an independent external review — it is a federally protected right.
Q: Should I switch plans every year during open enrollment? Yes — at the very least, you should be comparing your current plan against alternatives once a year. Your needs change, plan details change, and you might easily find a better deal.
Q: Can I use both an HSA and a regular savings account? Yes. An HSA is specifically for tax-advantaged medical expenses, while a regular savings account has no restrictions. If you can afford to, using both is a smart financial strategy.
Q: What is a formulary and why does it matter? A formulary is your insurance plan’s approved list of covered drugs, organized by cost tier. How much you pay depends on what tier a drug falls under. Choosing a generic or lower-tier drug can result in significant savings.
Q: Are mental health services covered the same as physical health services? Under the Mental Health Parity and Addiction Equity Act, most health plans are required to cover mental health services at the same level as physical health services. If you’re being charged more, that may be a violation worth disputing.
Q: What is the difference between an FSA and an HSA? Most employer plans offer an FSA (Flexible Spending Account), but there’s a “use it or lose it” rule — you must spend the balance by year-end. An HSA (Health Savings Account) requires a high-deductible plan but rolls over each year and grows tax-free.
Q: How do I find a patient advocate? Begin with your hospital’s patient services department. For independent advocates, visit the Patient Advocate Foundation at patientadvocate.org or the Alliance of Professional Health Advocates at aphadvocates.org.
The Bottom Line
Insurance is not only a safety net. It’s a financial tool — and like any tool, it doesn’t work unless you use it.
Every unclaimed preventive visit, every denied claim you didn’t appeal, every brand-name prescription you didn’t switch to a generic — that’s real money walking out the door. Month after month. Year after year.
The 10 powerful ways to maximize insurance benefits covered in this guide are not gimmicks. They are practical steps that any person — at any income level — can take starting today.
Read your EOB. Use your free preventive care. Appeal that denial. Open an HSA. Show up to open enrollment prepared.
The insurance system is built to be confusing. But now you know how it works.
Start using your benefits like you mean it.
