Maximizing Your Benefits with McLaren Health Plan

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Written by: Jennifer Gorman (*Amsive Digital)  |  Reviewed by: Shelley Wyant  |  *MHP partners with Amsive Digital on news content


Maximizing Your Benefits with McLaren Health Plan

Some people are unaware of the full list of benefits offered by their health insurance plan. Whether you have an individual plan, Medicaid plan, or Medicare Advantage plan from McLaren Health Plan, you may not be making the most of your benefits. By using your health plan strategically, you may be able to lower your out-of-pocket costs and take advantage of benefits that might otherwise go unused. 

This article will help answer your questions about your McLaren Health Plan benefits and offer some strategies for maximizing your coverage. 

Review Your Plan Online to Discover Limitations

You must know what is and isn’t covered to maximize your plan's benefits. You can review your most recent Summary of Benefits and Coverage document for details about covered services. You can also find up-to-date information about your health plan benefits with your online McLaren CONNECT account. 

Understanding your McLaren Health Plan limitations and exclusions is just as important. It helps you avoid unexpected expenses and budget for potential out-of-pocket costs. Some key coverage limitations to watch out for include:

  • Visit limits: Some services, such as physical therapy or chiropractic care, may be covered up to a certain number of yearly visits (like 18 or 20).
  • Dollar limits: Other services, such as eyeglasses (if your plan covers them), may be covered up to a certain dollar amount each year. 
  • Preauthorization requirements: Preauthorization means you or your provider must get your plan's approval before you receive a covered service. Without this approval, your plan might not pay for the service.
  • Excluded services: Health plans don’t cover every medical service or supply a person might want. Review your plan to find out what it doesn’t pay for or cover.

Review Our List of In-Network Providers

McLaren Health Plan has an expansive provider network that includes primary care physicians, specialists, urgent care clinics, hospitals, pharmacies, and more. You can visit our provider directory to choose from the thousands of providers who accept your plan. 

Referring to the list of in-network providers each time you need care helps you maximize your plan’s benefits. Prioritizing providers in the network ensures you receive the full benefits of your plan and avoid out-of-network fees, if any. 

Understand Out-of-Network Care Options

While McLaren Health Plan’s network is large, there may be times when you may need to seek care from out-of-network providers. For example, you may need services that are not available from an in-network provider. Before visiting out-of-network providers, it’s crucial to understand your plan’s out-of-network coverage options. 

Review your plan documents to learn when out-of-network care might be covered. Maybe you need emergency services or urgent care. You might also have the option to get out-of-network care if your plan approves it in advance, like if you need a type of care that isn’t available in-network. 

Some McLaren Health Plans are HMO-POS (Health Maintenance Organization with a point-of-service option) plans. If your plan is an HMO-POS, you can get certain services outside the network, though you’ll pay less if you stay in-network. Review your plan online for details about out-of-network benefits and costs. 

Explore the Perks and Additional Benefits of Your Plan

You might assume that your health plan only covers medical expenses, such as doctor visits and hospital stays. However, health insurance plans may offer a wide variety of additional benefits designed to help members save money and enjoy a healthier lifestyle. 

Sign into your McLaren Health Plan member account to explore everything your plan offers. Additional benefits vary by plan but may include:

  • Gym membership discounts: Staying active can improve your health, which is why some health plans offer a fitness reimbursement toward your gym membership fees. 
  • Medical support services while traveling: McLaren Health Plan members can get help finding urgent or emergency care providers in the area they’re traveling to. 
  • Mental and behavioral health support: Mental wellness supports can include services like therapy sessions or help quitting smoking. 
  • Telehealth services: McLaren Health Plan members can see a provider anytime, anywhere with McLarenNow virtual visits. 

Maximizing Benefits for Senior Members

If you’re 65 or older, there are some additional steps you can take to make the most of your McLaren Medicare plan. 

First, take advantage of your plan's preventive care benefits. Medicare Part B covers an annual wellness visit, which allows you to sit down with your primary care team and create a plan for staying healthy. That could include determining which tests or screenings you need in the coming year. 

Second, familiarize yourself with the additional benefits offered by your plan. McLaren Medicare Advantage plans offer some extra benefits that Original Medicare doesn’t cover, such as dental care, transportation to and from medical appointments and even personal emergency response systems. 

Finally, review the formulary, which lists all drugs your plan covers. Find out if your plan covers your drugs, and if not, talk to your doctor about potential alternatives. The formulary also notes any limitations to your drugs, such as quantity limits. 

How McLaren Health Plan Can Help:

Learning more about your health plan helps you maximize your benefits. Review your plan to learn what it covers, what it doesn’t cover, and the rules to follow when accessing care. If you have questions about what your plan covers or how it works, call Customer Service at 888-327‑0671 (TTY: 711).

McLaren Health Plan offers individual/family plans, Medicaid plans, Medicare Advantage plans and Medicare supplement plans.

Discover your perfect plan