Health-care consumers need to know their facts
Your employer and President Obama are imploring you to become a better health care consumer. They want everyone to take a more active role in their care because it’s vital to help slow the seemingly perpetual rise of health care expenses.
A growing number of companies offer high-deductible health plans that make their employees pay more for care out of pocket. Some workers also are finding that the cost of their coverage is now tied to the quality of their health or whether they smoke.
President Obama’s health care overhaul promises to provide insurance coverage to millions of Americans. But the uninsured first have to figure out which plan suits them best.
Becoming a better health care consumer shouldn’t require prodding because it can put more money in your pocket and keep big medical bills at bay. Here are four key principles to keep in mind.
1. YOUR NUMBERS MATTER: Many companies now provide biometric screening to their employees, and it’s not a bad idea to take them up on the offer. This involves measuring variables such as body weight, cholesterol and blood pressure that can tell you whether you’re at risk for developing heart disease or other problems.
Companies do this in part because they want their workers to nip health problems before they become full-blown — and costly — medical emergencies like a heart attack or diabetes. That means finding the right cholesterol drug or figuring out an exercise plan that helps you drop a few pounds and leave the cardiac risk zone.
Businesses frequently hire outside firms to coordinate these tests, so your boss won’t know your individual test results, but the company may get data showing the averages for those covered under their plans.
2. HEALTH INSURANCE KNOWLEDGE PAYS: Knowledge is power, and in this instance, that power can help you avoid debt. Do some research before buying coverage.
You need an idea for what type of coverage fits best. For instance, if you don’t have significant medical expenses, consider a high-deductible plan. It will cost less than more traditional plans, but the catch is you will have to pay more out of pocket when you use the medical system.
That $20 co-payment at the doctor’s office may be replaced by a $90 bill.
Before committing to a plan, understand what kind of bill you may receive for surgery or a hospital stay. Then you can think about how easy or hard it would be to come up with that money. Do you have $5,000 stashed in a savings account to put toward an unexpected medical bill?
Look for a plan benefits summary that lays out key variables, such as the annual deductible, which is what you pay before most coverage starts. Also look for the co-insurance, which is the percentage of a bill from a big medical expense like surgery generally after you pay your deductible.
A plan may offer 90 percent coinsurance, which would leave you with only 10 percent of the bill. That sounds great, but 10 percent of a $9,000 surgery is $900.
3. ALL PRESCRIPTIONS ARE NOT PRICED EQUALLY: Many patients with prescription drug coverage are enrolled in a plan that offers three or more payment levels. Savings can be found by sorting through these tiers.
First-tier drugs come with average co-payments of $10, the second tier averages $29 and the third averages $52, according to a recently released study of employer-sponsored health insurance from the Kaiser Family Foundation.
If you have tiered coverage, ask your doctor if your prescription has a lower-tiered equivalent. Pharmacists also can check with doctors and adjust prescriptions from brand-name to generic, if a good option is available, said Carolyn Castel, a spokeswoman for CVS Caremark Corp., the nation’s second-largest drugstore chain.
4. IT HELPS TO SHOP AROUND: The doctor’s office has been the traditional destination for patients with the flu, bronchitis or a nasty case of poison ivy. But those visits can be pricey for patients with high-deductible insurance.
Walk-in clinics have been added to many drugstores and grocery stores over the past decade, and they may offer a better deal. Care at these places is typically handled by a physician’s assistant or nurse practitioner.
Consider shopping around for surgery or care that isn’t urgent, like a shoulder scope or an MRI exam. There may be a wide variation of prices charged among providers in your network, and that means you could find big savings for the portion of the bill you have to pay.
Unfortunately, shopping around doesn’t mean making three phone calls to get three prices. Hospital pricing is murky and can depend on a patient’s coverage. Plus a patient may receive more than one bill for a procedure.
Check to see if your health insurer has any tools to help you estimate your out-of-pocket expenses. They might be able to give you a reasonable idea, since the insurer will know coverage details like which doctor is in your plan’s network.
The nation’s largest insurer, UnitedHealth Group Inc., offers an online cost estimator that give customers approximations of their costs tailored to their coverage and factors such as whether they have met their annual deductible.
It can find some wide variations, depending on the provider. For instance, the bill for a knee MRI done in Seattle can range from $92 to $494 for a patient who has paid his deductible and is responsible for a 20 percent coinsurance payment.
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