The U.S. healthcare industry is weird. Virtually every American has health insurance in some form or another, and yet the vast majority of us don’t actually know what it does or how to use it wisely.
As the year winds down, many are reviewing the current state of their health plan and wondering how to get more out of it going forward.
After working in the health insurance industry for a few years, I realized that simply offering insurance plans and quotes to people was not the right approach. I needed to provide solutions for pain points. After researching the marketplace and learning as much as I could about the ins-and-outs of health insurance, I learned a few valuable strategies.
Below are my quick tips to start 2016 with the right health plan and end 2016 with more money in your pocket!
1. Take time to review your options
A 2014 poll showed that 41% of employees spend 15 minutes or less reviewing benefits options even though their yearly premiums now average $4,565. Yet, they’ll spend 8 times longer to research a television purchase and 40 times longer to research a new car purchase. It’s a big chunk of your budget, so spend a few minutes reviewing your medical plan choices to determine which will be the best for you and your family. If you’re not getting insurance through an employer, I suggest finding a quality local health insurance broker to help you navigate through the decision. There’s no additional cost to use their expertise, so a broker is a good partner to have in your corner.
2. Review your healthcare usage
Take a few minutes to audit your family’s medical history and annual healthcare usage. Looking at past years to get an idea of how often you visited the doctor and urgent care clinics, or how many prescriptions you needed can provide you with valuable information as you’re choosing a plan. Some questions to ask: Are you willing to have higher co-pays with a lower premium? Do you need to use a certain doctor and is that doctor in-network on the plan you’re considering? Is your medication covered on the plan you’re considering? Sometimes a slightly higher per-month premium comes with a substantially better network of doctors, or your prescription might be covered under one plan vs. another.
3. Shop around
With more and more plans structured around higher deductibles and less coverage, it’s important to shop around for the best pricing on healthcare services and to learn the cost before receiving the service. Just choosing an “in-network” provider doesn’t necessarily mean you’ll pay the best price. The use of pro-consumer transparency tools can help. Consider subscribing to an advocacy service. Members are assigned a personal advisor to help with a wide range of medical and insurance queries. While surfing the Internet can get you a random estimate, an advocate can review your insurance plan, in-network (or out-of-network) providers with quality ratings, and location to get you a pretty darn good idea of what you’ll be paying out of pocket.
4. Take advantage of lower cost options to access care
Popcorn at a movie theater is $6 - $8 a bag vs. a convenience store at $1 or a grocery store at $.30. Healthcare works the same way – the same advice/service can cost a lot more depending on where you get it. In a true emergency, dial 911 or head to the ER. But for vast majority of other issues, consider other options such as telehealth or walk-in clinics to address these. Telehealth can afford you the opportunity to stay at work and stay out of traffic and a waiting room by quickly and easily speaking to a board-certified licensed physician who can even write you a prescription, if appropriate! Walk-in clinics, such as those located inside pharmacy chain stores, can do basic medical care quickly and possibly at a lower cost than an urgent care center. If all you need is some good old-fashioned advice, don’t turn to Google, WebMD, or your friends on Facebook. Try an online doctor service that provides access to specialists through email - all while skipping the hassle of a typical doctor visit. Pharmacists, psychologists, dentists, dieticians and more are all available to give you personalized answers to your medical questions in a few short hours.
5. Switch to generics
The FDA states that generic medications use the same active ingredients and work the same way in the body as brand-name drugs, but they cost 30% to 80% less. These savings are further exaggerated when looking through the lens of your medical plan’s co-pay. With more plans moving to prescription tiers that give you deep discounts on generics and severely limit your savings on name-brand drugs, looking for the generic equivalent for your prescriptions can save you a ton throughout the year!
6. Utilize your plan to your advantage
Medical plans have what’s called an out-of-pocket max, which is the most you’ll pay in a year (the next year, your new plan will start back at $0). Now that the Affordable Care Act allows co-pays to count toward your out-of-pocket max, it’s possible that you’ll hit that limit sooner (except that today’s plans have higher out-of-pocket max amounts). If you’re at or near the limit, schedule your non-urgent procedures and services to avoid paying the full cost in the following year.
Yes, health insurance is confusing. Yes, it’s expensive. Yes, it seems there’s an asterisk at the end of every sentence. But new tools and resources are emerging to help. Let’s learn how to use our health insurance to receive the care we need and save money at the same time!