USA. What questions/codes/etc should I ask my doctor for and my insurance company for to find out if a test or drug or xray will be cheaper to have insurance cover it vs going to a 3rd party company to do it out of pocket?

I do this sometimes because my insurance isn’t great. As others have said, it doesn’t relate to your tax credits. Here is more detail on how it relates to your coverage:

-You have an annual deductible. There are certain services that your insurance won’t cover until you meet your deductible. So, if you have a $1,000 deductible, you may not get any coverage for specialist visits (or many other services) until you have spent at least $1,000 yourself.

-You have an annual out-of-pocket maximum. Your plan must cover 100% of all services after you have paid out the out-of-pocket maximum. So if your out-of-pocket maximum is $5,000, your plan will pay for 100% of your covered expenses after you have spent $5,000 in the year.

-I have a medication that costs $100/month if I buy it through my plan but only $70 if I buy it through a discount program. If I use my insurance, I am paying $30 more each month but that $100 a month is counted toward my deductible and out-of-pocket maximum. If I use the discount program, I save the $30, but my insurance company does not count the $70/month towards my deductible or out-of-pocket maximum. Let’s say I have a $1,000 deductible and I have to go to the ER in June and my insurance does not pay for ER visits before the deductible is met. If I had used my insurance for the drug, I would have already paid $500 towards my deductible and I would only have to cover $500 of my ER visit before the insurance kicked in. If I had bought the drug with the discount program, I would still have to pay my entire $1,000 deductible on the ER visit. In this case, I still use the discount program because I tend not to have a lot of healthcare expenses.

-For lab work it’s a little more complicated. I have diabetes and get my average blood sugar checked every six months. When I didn’t have insurance, I used third-party services, which charge about $25 for the test and don’t require a doctor visit. With my insurance, I have to pay $25 for the doctor visit and $15 for the test, so it still is more expensive than paying myself. In this case I just do it with my doctor because it’s only a couple of times a year and I would want to see my doctor anyway. Just like with the medication, if I get the test myself, the $25 doesn’t count towards the deductible and out-of-pocket maximum, but the $40 does count when I use my insurance.

It still shouldn’t be too hard to check – if you search CPT code for whatever test you want, you can ask your insurance company what they would charge for you to get that test and compare it to the cash-pay lab cost.